20150202 Permit Pkg 05272015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: NORM BOE
Address: 16408 NE FARGO ST.
PORTLAND OR 97230
Property Information:
Site Address: ?in STFVFNC AVF NF
Assessor Parcel No.: 64421400400
Contractor Information:
Name: NORM BOE
Address:
16408 NE FARGO ST.
PORTLAND OR 97230
Contractor License No.:
Permit No.: 20150202
Issue Date: 5/27/2015
(Work must be completed within 180 days)
Phone:
Owner: NORM BOE
Subdivision: Lot:
Phone:
Expires: 0 /00 /0000
Project Information:
Project: MECHANICAL
Description of Work: REPLACE 50 GALLON GAS WATER HEATER
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
WASHINGTON ENERGY SERVICES
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 Washington.
r
Signature / ' Date 6
Firmly &.r ml 1 !� for W c! ! rr n
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Mi
(36 ) 458 -3244
REC #: 00196394 5/27/2015 3:00 PM
OPER: CO TERM: 001
REF #: 2286
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20150202 29.50CR
BOE, NORM
210 STEVENS AVE NE
MECH 29,50CR
TENDERED: 29,50 CHECK
APPLIED: 29.50 -
CHANGE: 0.00
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 210 STEVENS AVE NE
Subdivision: Lot #:
Parcel #: 64421400400
Zoning;
al6c 002-
Li New Construction vt Re -Model / Re -Roof / Addition ❑ Home Occupation Sign
❑ Plumbing 4( Mechanical ❑ Mobile / Manufactured Home Placement ❑ Other
Project Description /Scope of work: REPLACE 50 GAL. GAS WATER HEATER
Project Value:
Building Area (sq. ft) 1 st Floor 2 I Floor Garage Deck
Basement Carport Patio
# Bedrooms_ # Bathrooms_ Heating: GAS /OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
lj I G OWNER NAME: NORM C BoE / /�� AIE T6,4,0 .St , or�{1��, , or ?U z O
ADDRES 149 A EMAIL
CITY ' /"', STATEI@ LUA,-ZIP��TELEPHONE 503- 255 -2229
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR Washington Energy Services TELEPHONE 800 - 398 -4663
ADDRESS 3909 196th St SW EMAIL
CITY Lynnwood STATE WA ZIP 98036 FAX
CONTRACTOR'S LICENSE # WASHIES9710B EXP DATE9i15 CITY LICENSE # 30501
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.
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. f
Applicant's Signature Date
Owner / Contractor / 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
MAY 2 7 2015
105 Yelm Avenue West (360) 458 -3835
PO Box 479 (360) 458 -3144 FAX
Yelm, WA 98597 WWWA.yelm.Wa.us