M-05-0122
i~
~
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name. Washington Energy Service
Address. 2800 Thorndyke Ave. W
City' Seattle
Property Information:
Site Address. 1307 Chrystal Springs Road
Assessor Parcel No. 22718330302
Subdivision:
Contractor Information:
Name: Applicant
Address.
Contact:
City'
Contractor License No
Expires.
Project Infol1Tlation:
Project: Mark Ziebell
Description of Work: 2.5 Ton Heat Pump
Sq. Ft. per fiour (1st) 0
(2nd) 0
(3rd) 0
Heat Type (Electric, Gas, Other)
Fees:
Item
Item Fee
Base Amt
Unit Fee
Mechanical Permit
TOTAL FEES.
33.25
$33.25
000
Applicant's Affadavit:
Date
Firm
Permit No
M-05-0122-Yl
Issue Date 05/13/2005
(Work must be started within 180 days)
Receipt No
Garage 0
Unit Rate
000
0.0000
36736
Phone:
206.282.4700
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor, I futher certify that I am currently
registered in the State of W 'ngton.
JI/rfIoJ
State WA Zip 98199
Lot:
Phone:
State:
Zip:
Business License:
8asellient 0
No. Units Unit Desc
o 0000
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:~
By' to~\..\
\
I
I
I
I
I MAY 1 2' Z005- ,
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RECEIVED
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MEMORANDUM
City of Yelm
Community Development Department
To Washington Energy Service
Attn Candice Gallagher
From Roberta Allen
Date May 16, 2005May 16, 2005
Subj Mechanical Permit
Enclosed please find the receipt for payment of the Mechanical Permit M-05-0122-YL
for an electric heat pump at 1307 Crystal Springs Road NW in Yelm, WA. Also please
-I:"",,'" ...h....... :_____...:__ __....J &._.. ___",:__ _j, .&.L_ _...._
'" ,... ., Iv 1I1~t_''"''''.,VII '-'01 U I VI t_'V>)UII~ Ol U IC >)IlC
Please sign the enclosed permit page, at the bottom, in BLUE ink. Retain a copy for
your office and return the original to our office at
Community Development Department
City of Yelm
POBox 479
105 Yelm Avenue West
Yelm, WA 98597
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360)458-3144
Permit No
M-05-0122-YL
Issue Date. 05/13/2005
(Work must be started within 180 days)
Receipt No
36736
Applicant:
Name: Washington Energy Service
Phone:
206.282.4700
Address. 2800 Thorndyke Ave. W
City' Seattle
State' WA Zip 98199
Property Information:
Site Address: 1307 Chrystal Springs Road
Assessor Parcel No. 22718330302
Subdivision.
Lot:
Contractor Information:
Name: Applicant
Contact:
Phone:
Address.
City'
State:
Zip:
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~ -_:_--
L..^t-'IIt:;;;".
DU::"IIt:::.::. L'l;t:I1::'t:.
Project Information:
Project: Mark Ziebell
Description of Work: 2.5 Ton Heat Pump
Sq. Fl. per floor' (1st) 0
Heat Type (Electric, Gas, Other):
(2nd) 0
(3rd) 0
Garage 0
Basement 0
Fees.
Item
Item Fee
Base Amt
Unit Fee
Unit Rate
No. Units Unit Desc
Mechanical Permit
TOTAL FEES.
33.25
$33.25
0.00
000
o 0000
0.0000
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Signature
Date
Date:
By'
Firm
RECEIVED
RECEIVED FROM
""THIRTY THREE DOLLARS & 25 CENTS
RECEIPT No 36736
WASHINGTON ENERGY SERVICES
2800 THORNSYKE AVE W
SEAT'I'LE l'IA 98199
SITE 13074 CRYSTAL SPRINGS
DATE
REC NO
AMOUNT
05/13/05 36736
BUDGE'I'ARY
33 .:5 CHECK
REF NO
4688
---'-~- --'------ -------~~HgUE_____________________ _~,_
NECH PERMIT 33 25
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
App1ica.llt:
Name. Washington Energy Service
Address. 2800 Thorndyke Ave. W
ProjE!ct Inf()l1TIati()n:
Project: Mark Ziebell
City' Seattle
Description of Work: 2.5 Ton Heat Pump
Site Address. 1307 Chrystal Springs Road
Item
Mechanical Permit
Acct Code
Permit Fees Schedule
Permit No M-05-0122-YL
Phone.
State: WA Zip 98199
206.282.4700
Assessor Parcel No. 22718330302
032001-322-10-00
33.25
Item Fee Base Amt Unit Fee
000
Unit Rate No. Units Unit Desc
o 0000
TOTAL FEES.
$33.25
000
o 0000
PAID
MAY 1 3 2005
CITY OF YELM
3b73~
/
!
I
TO 13604583144
.14 FROM
CITY OF YELM
RESIDENTIAL BUilDING PERMIT APPLICATION FORM
Project Address: i ~ D 7 ~ Jb.J f fJr] nfJ tJ;J Parcel #. ~2 1 I P 3 30 J'd2
Subdivision: lot #. ,J.J0 Zoning;
I New Construction I ~Modell Re-Roof I Addition II Home Occupation Sign
I Plumbing ~chani~I I Mobile I Manufactured Home Placement Other
Project Descr18lion/Scope of wOrk:~~11 +U..d- (Ju h1fJ '2.. &C;- ~
Project Valu<.J)) '3 I U2 &> 2. .... 00
P 1
Building Area (sq. ft) 1st Floor 2nd Floor Garage Deck
Basement Carport Patio ~
# Bedrooms_ # Bathrooms_ Heating. GAS/OTHER O~CTR~irde One)
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit applicalion.
ARCHITECTIENGINEER
ADDRESS
CITY
LICENSE #
ZIP
TELEPHONE
STATE
GENERAL CONTRACTOR
ADDRESS
CITY 5T ATE
CONTRACTOR'S LICENSE #
TELEPHONE
FAX
EXP DATE
ZIP
CllY LICENSE #
PLUMBING CONTRACTOR
ADDRESS
CllY STATE
CONTRACTOR'S LICENSE #
TELEPHONE
FAX
EXP DATE
ZIP
CITY LICENSE #
LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable.
, hereby certify that the above Information Is cormct and that the construction on, and the occupancy and the use
of tho above descrfbod property will be In IIc;cordanco wtth tho laws, rulos and Ngulatlons of tho Ststo of
Washington and the City of Yelm. ~Z--J7 7 C> "5 ~
L//2.cJ jd./
Date
ease circle one.)
All permits are non-transferable and will expire if work authorized by such permit is not
begun within 180 days of issuance, or If work Is suspended or abandoned for a period of
180 days
R.;ICommunity Development\Fonns & PmccdureslBuiJding PermilSlRl:sBldgPcn:n.iLApp.doc
Page 2 00
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