20150213 Permit Pkg 06022015Applicant:
City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458-3144
Permit No.: 20150213
Issue Date: 6/02/2015
(Work must be completed within 180 days)
Name: DENNIS COATES Phone:
Address: 14439 LOCKWOOD LN SE
YELM WA 98597
Property Information:
360- 420 -4851
Site Address. 14439 LOCKWOOD LN SE Owner: DENNIS COATES
Assessor Parcel No.: 78640110500 Subdivision: TAHOMA TERRA
Contractor Information:
Name: BLACK HILLS, INC Phone: 360- 239 -3776
Address:
Lot: 105
1003 85TH AVE SE
OLYMPIA WA 98501
Contractor License No.: BLACKH1066JL Expires: 3/31/2016
Project Information:
Project: MECHANICAL
Description of Work: ADD AIR CONDITIONER. DUCK LEAKAGE AFFIDAVIT REQUIRED.
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
BLACK HILLS, INC
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.
Signature i Date
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Yelm
(36) 458 -3244
REC #: 00196640 6/02/2015 2:58 PM
OPER: CO TERM: 001
REF #: 16104
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20150213 29.50CR
COATES, DENNIS
14439 LOCKWOOD LN SE
MECH 29.50CR
TENDERED: 29.50 CHECK
APPLIED: 29.50-
CHANGE: 0.00
TRAJ�
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: �L�U2!S �UC(100QfJ LftGEParcel #: latubtluEno
Subdivision:
Lot #: Plan #: Zoning:
❑ New Construction - Re -Model / Re -Roof / Addition I Home Occupation Sign
❑ Plumbing x� Mechanical Mobile / Manufactured Home Placement Other
Project Description/Scope of Work: G—d . aix
`—t IJZ,t'
Project Value: 4b l� 00
Building Area (sq. ft) 151 Floor 2nd Floor 3 d Floor Garage -2 car 3 car
Covered Patio Covered Porch Patio Deck
# Bedrooms_ # Bathrooms_ Heating: GAS /OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
/f yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: S
ADDRESS S J EMAIL
CITY STATE_10A_ZlLq5 TELEPHONE 3 W a0 - U gI
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR tl5 TELEPHONE :aJ9')= lCFzi '!0
ADDRESS u 4 EMAIL
CITY STATE W P, ZI FAX
CONTRA R'S LICENSE # AjZaTT Notn11EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Commun t�1 10ols, if applicable U� 3�Ce • O
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
Cit of Yelm.
b2o�� Ly LR hs-
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 180days _
`�
JUN 0 2 2015
105 Yelm Avenue West (360) 4
Yelm, WA 98597 (360) 4
www.ci.yelm.wa.us