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