Loading...
20150200 Permit Pkg 05222015City of Yelm Community Development Department Building Division Phone: (360) 458 -8407 Fax: (360) 458 -3144 Applicant: Name: JERRY /ERIN PRICE Address: 16228 PRAIRIE CRK LP SE YELM WA 98597 Property Information: Site Address: 1977R PRAIRIF r-RFFK I P -RF Assessor Parcel No.: Contractor Information: Name: MIKE MOORE PLUMBING REPAIR Address: MIKE & SUE MOORE PO BOX 327 EAST OLYMPIA WA 98540 Contractor License No.: 11068 Subdivision: Permit No.: 20150200 Issue Date: 5/22/2015 (Work must be completed within 180 days) Phone: 360- 400 -1547 Owner: JERRY PRICE Lot: Phone: Expires: 12/31/2015 Project Information: Project: PLUMBING Description of Work: REPLACE GAS WATER HEATER Sq. Ft. per floor: First Heat Type (Electric, Gas, Other): Second Third Garage Basement Fees: Item MECHANICAL Contractor MIKE MOORE PLUMBING REPAIR TOTAL FEES: Applicant's Affidavit: 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 further certify that I am currently registered in the State of Wash' ton. Signature Date Firm Fees $ 29.50 $ 29.50 OFFICIAL USE ONLY # Sets of Prints: Final Inspection: Date: By: City of Yolm (36 ) 458 -3244 REC #: 00196234 5/22/2015 4:15 PM OPER: CO TERM: 001 REF #: PAID BY: ACCT #: XXXXXXXXXXXXXXXXXXX AUTH #: 061425 TRAN #: 000000001744 TRAN: 33.0000 BUILDING PERMITS 20150200 29.50CR PRICE, JERRY /ERIN 16228 PRAIRIE CREEK LP SE MECH 29.50CR TENDERED: 29.50 CREDIT CARD APPLIED: 29.50- CHANGE: 0.00 ZofSC 2ccD CITY OF YELM II RESIDENTIAL BUILDING PERMIT APPLICATION FORM Project Address: l �LZ� r� �l Er •(,1�- Parcel #: ` Subdivision: Lot #: Z Plan #: Zoning: New Construction Re -Model / Re -Roof / Addition 1 Home Occupation Sign ,Plumbing Mechanical Mobile/ Manufactured Home ` Placement Other Project Description /Scope of Work: 1(tu 6 S ✓`L4QN �.'✓ Project Value: Building Area (sq. ft) V' Floor t Q 2nd Floor Garage q00 Deck _ Basement k' Carport ')� Patio # Bedrooms # Bathrooms_ Heating: GAS /OTHER or ELECTRIC (Circle One) Are there any environmentally sensitive areas located on the parcel? V_ If yes, a completed environmental checklist must accompany permit application. BUILDING OWNER NAME: ADDRE S 11-7-1 ` I i L EMAIL r G6���S -� K4 CITY STATE ZIP C , TELEPH NE - O 2 ARCHITECT /ENGINEER LICENSE # ADDRESS EMAIL CITY STATE ZIP TELEPHONE GENERAL CONTRACTOR /tlt "-P, 9-40-0Y _ TELEPHONE ADDRESS 12 � LP\ L& EMAIL CITY / TATE-.1AIIZIP S� FAX CONTRA R'S LICENSE # OJ\J Flf r- EXP DATE CITY LICENSE # PLUMBING CONTRACTOR TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE # MECHANICAL CONTRACTOR TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE # Copy of mitigation agreement with Yelm Community Schools, if applicable. 1 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. e'll, L-1 Applican Signature Date / Owner / C ntractor / Owner's Agent / Contractor's Agent (Please 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 105 Yelm Avenue West Yelm, WA 98597 www.ci.yelm.w¢.us MAY 2X2015 (360) 458 -3835 FAX