20040090
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
registere~ ~tate of waShingtp
Signatur~~~L/~ Date 7.- /-G}~
Firm ' /
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name Robbins Heating and Cooling
Address. POBox 775
City. Packwood
Property Information
Site Address 311 Cullens Road
Assessor Parcel No 21724140502
Subdivision N/A
Contractor Information
Name Robbins Heating & Cooling
Contact:
Address POBox 775
City. Packwood
Contractor License No. ROBBIHC022BG
Expires. 08/22/04235
Project Information
Project: Easthaven Villa
Description of Work: Install Three Heat Pumps
Sq. Ft. per floor. (1 st) 0
(2nd) 0
(3rd) 0
Heat Type (Electric, Gas, Other)
Fees
Item
Base Amt
Unit Fee
Item Fee
Mechanical Permit
TOTAL FEES
4850
$48.50
000
000
Applicant's Affadavit:
Permit No
M-04-0090-YL
Issue Date 07/07/2004
(Work must be started within 180 days)
Receipt No
32252
Phone
360-494-6100
State WA Zip 98361
Lot: N/A
Phone: 360-494-6100
State. WA Zip
Business License. 03-002395
Garage 0
Basement 0
Unit Rate
No Units Unit Desc
o 0000
o 0000
OFFICIAL USE ONLY
'#Sets of Prints
Final Inspection
Date.
By.
~
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit Fees Schedule
Permit No M-04-0090-YL
Applicant:
Name Robbins Heating and Cooling
Phone
360-494-6100
Address POBox 775
City. Packwood
State WA Zip 98361
Project Information
Project: Easthaven Villa
Description of Work: Install Three Heat Pumps
Site Address 311 Cullens Road
Assessor Parcel No 21724140502
Fees
Item
Acct Code
Item Fee Base Amt
Unit Fee
Unit Rate
No Units Unit Desc
Mechanical Permit
032
001-322-10-00
48.50
000
000
o 0000
o 0000
TOTAL FEES
$48.50
PAID
JUL 0 7 2004
C\TY OF YELM
j f(jS?
ProJect Address
Zoning, Veih...
CITY OF YELM
COMMERCIAL BUIl.DING PERMIT APPLICATION FORM
,:JJI ~/e;..s M Parcel#' ,)/V?ltJOW::J-
'/'H
C1'l-lI Current Use: ~w.t. ~~0f50sed Use.
I
o New Construction 0 Re-Model/ Re-Roof I Tenant Improvement
o Plumbing ~ Mechanical 0 Fire Prevent/Suppress/Alarm 0 Other
Project Description/Scope of Work: 11M If;t.,b )..ultry S1~
Project Value. 1?_~-7A..md cd ~ 11tf,tXX)
BUilding Area (sq. ft) Parking Garage 1st Floor I( 2M Floor 3(0 Floor_
Building Height
Are there any environmentally senSitive areas located on the parcel?
completed environmental checklist must accompany permit application.
If yes, a
ZIP
TELEPHON
~B..G..t.jft~c-Pl~N,GJ.N ;~11
ADDRESS
CITY STATE
GENEAAG~Q~86~t9R
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
8ttJ M!3I:NGtqobllF~AGtOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
~~m~;~~N
ZIP
LICENSE #t
TELEPHONE
TELEPHONE
ZIP
FAX
EXP DATE CITY L1CENSE:t
TELEPHONE
ZIP
FAX
EXP DATE CITY LICENSE //
~ 100
Copy 01 City MItigation documentation (TFC).
I hereby certify that the above information Is correct and that the construction on, and the occupancy and the use
of the at/ove described property will be in accordance with the laws, rules and r~9ulalion5 of the State of
Washington and the City of Yelm.
~
Applicant's Si natum
Owner I Contractor I Owner 5 Agent / Contractor's Agent! Tenant
8')/RI ~'/
Date
(Please circle one,)
All permits are non-ti:ansferable 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
I \{ (JII\I:IUtlll'i lkvCI()rrnr'l1t\I'o(I:1~: .5i. l'.()("('d\lr<.:\\dulldllll' rl('.frni I( ()nlTn!~ld~P:':it;l1i.".\r;~ ':.H..
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08/10/04 TUE 14 46 FAX 253 596 3,827
:Jt:;cJ f 1;$4, '131 @ ELECTRICAL WORK PERMIT APPLICATION
V U Request Inspection 2146419
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. '\ JfJ.b~d by 0 &]~Iea] contraetclr 0 OWJIer Ima~:ti; dcscri9tiou .,'"
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1\ Electrical c:ontmctoT IJlIDIe License number I
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~g mailin;~
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CitY a Sew: ZIP
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Telc:phoJ number FAX number
LABOR & INDUSTRIES TAC
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Thermosmt Q Telecom.
cruises ownc:r'~ ume
F"U2..cI /h L4 L Q M
Address lie iDopectloa
3// Ci.,fLL ens ..5-t NW
CIty YeA . 3 County
/1J . /7 ln1pCCt~cc
.. U Cash Check # ~ ~ $ (.p
L~~~~~.
Power company
. P lASj e -6 I? to vv ~ (, ,
1 hereby certify that MID the oWller of the above named propcrty or a
licensed electrical contractor (or the: firm's authorized agent) and am
makmg the electrical installation or alteration in compliance with the "
electrical law, Chapter 19.28 RCW . ./
Cha em contraetor's account.
SIgnDWrIl of owner, electrical toatTador or dcc:trical luhninistrator
~'f)c
~: ;
~
;~~.?r~~i~~~~#~:f(fu:~i~~~;>...
[)()4/30 ({3L(
Please Draw Map Bdow frOm the Nearest MaiD Street or Highway
~ctivity ID : 2Q0413~134
~rPliJ:Etio~ ~ 21~~~1~i
ir~ns I~ ; :~05~59t4
OS/1~j20Q4 14:46
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PvOOOl/JS I~ 1-z.. B19
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To assist uS in providing better service to you,
please fill out the applie&ion paying
pllrticular attention to the following in:ms:
'-ICZJ
?/
I Complete all appropnate blanks.
2. Provide detailed description of installation.
Do not remove or conceal
3. Provide detailed map to jobsitc.
#
C, Rc..\J IT ~
4. I f no home phone number is available, please
provide message number.
5. Make check payable to tbe Dept. of Labor &
Industries.
Electrical
Approval
6. If you are mailing this in, please remove hard
copy to post 011 the jobsite and send the top 3
copies to the appropriate semce location.
Dept. of Labor
& Industries
F500-OO5-000 (5.93)
7 Sigtler is OWDer only if not wimI by an
electrical contractor.
8. If wired by an electrical contractor, must be
signed by administrator or autborized designL'C.
lfyou have questions, please feel free to ask us!
Department of abor &. Industries
Electrical Set.tion
FSOo..OOl-OOO electrical work permit application rev 5-03
INSPECTO~