M-05-0113
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
M-05-0113-YL
Issue Date 04/13/2005
(Work must be started within 180 days)
Receipt No
36147
Applicant:
Name: Advanced Filter & Mechanical
Phone.
253.770.2440
Address. 418 Valley Ave. NW Ste. 8115
City' Puyallup
State. WA Zip 98371
Property Information:
Site Address. 16410 Cascadian Ave. SE
Assessor Parcel No 84070000800
Subdivision:
Lot:
Contractor Information:
Name:
Contact:
Phone:
Address.
City'
State.
Zip.
Contractor License No
Expires.
Business License.
Projj!ct InformatiCln:
Project: Ramirez AlC
Description of Work: 1 1/2 ton AlC and Electronic Air Cleaner
Sq. Ft. 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.
39.00
$39.00
000
000
0.0000
o 0000
Appli~ant's_Affadavit:
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 Washington.
Signature ~.._. ~. ~ ~ ..--""
~ - ~.....
Firm
OFFICIAL USE ONLY
# Sets of Prints.
Date
~
RECEIPT No 35147
RECEI\/E.D
REf ~IO
11772 \
\
\
\
,------"--------------=~------<---------'-----'/_---'--'-- ..-..----- ------
MECH PERHIT SITE 16410 CASCADIAN AVE SE
....THIRTy NINE DOLLARS & 00 CENTS
DATE
04/13/05
REC NO
36147
^~~nUNT
39 00 CrreCK
RECENED FROM
ADVANCED FILTER & MECHANICAL
418 VALLEY AVE NW STE Bl15
PUYALLUP WA 9B371
MISCELLANEOUS RECEIPT
MICHELLE
~,~'~l
I~
~
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit Fees Schedule
Permit No M-05-0113- YL
Applicant:
Name: Advanced Filter & Mechanical
Phone.
253.770.2440
Address. 418 Valley Ave. NW Ste. 8115
City' Puyallup
State. WA Zip 98371
Project Information:
Project: Ramirez AlC
Description of Work: 1 1/2 ton AlC and Electronic Air Cleaner
Site Address. 16410 Cascadian Ave. SE
Assessor Parcel No. 84070000800
Fees:
Item
Acct Code
Item Fee
Base Amt Unit Fee
Unit Rate No. Units Unit Desc
Mechanical Permit
032001-322-10-00
3900
0.00
000
o 0000
o 0000
TOTAL FEES.
$39.00
c
o
o
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: i b4 10- [0.5('0 ~ 'fi''"'I AueSi- Parcel #. 'i{Lj 61 OOr'! 0 ~ GO
;;~~""~, "
4p/f j ~ ~~>
Jill/If
Subdivision.
Lot#"
Zoning;
u New Construction U Re-Model/ Re-Roof / Addition U Home Occupation Sign
U Plumbing .~Mechanical U Mobile / Manufactured Home Placement U Other
Project Description/Scope of Work: .~ ~ ,~f\ Ie - E 'pc t ~C') n ie... )\, 1\., c 'Pn~ ,,--
Project Value: Ji4 7 q 1 I g c;
Building Area (sq ft)
1st Floor
Basement
# Bedrooms_
# Bathrooms_
2nd Floor Garage Deck
Carport Patio :} ,d e y Ccr ~
Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
completed environmental checklist must accompany permit application
If yes, a
BUILDING OWNER NAME. .-
ADDR~SS it.. ~ 10 -" C c.~ Q. ~l (;'''' AU(". s r
CITY 'f-r: IIV'! STATE LuG, ZIP ci'~ ~-Y1
EMAIL
TELEPHONE .:~? (') -- 400- 0 ~ :;3
ARCHITECT/ENGINEER
ADDRESS
CITY STATE
LICENSE #
EMAIL
TELEPHONE
ZIP
GENERAL CONTRACTOR A(\.}~;'\,.,:; l'lf 'I~"'L
ADDRESS i.f1'S-Vc. /Ji''i~'< ).il.U Ail~'
CITY.pR:r"""~ STATEWci. ZIP
CONT CTO 'S LICENSE # " ".- ,
'i Ilk liTELEPHONE l";$- 7 7'7--':.1 Y f D
EMAIL
q!r'3-]/ FAX ?sj-77P-';}yv'?>
EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
ZIP
MECHANICAl CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
ZIP
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the
above described property will be in accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
C\,;-,. _~'d-:t^~ ~
Appliqpnt's Signature Date
Ownef J Contractor J Owner's Agent I Contractor's Agent (Please circle one.)
All permits are non-transferable and will expire if work authorized by such permit is not begun
within 160 days of issuance, or if work is suspended or abandoned for a period of 180 days
105 Yelm Avenue West
PO Box 479
Yelm, WA 98597
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wa.U8