20150252 Permit Pkg 07102015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Permit No.: 20150252
Issue Date: 7110/2015
(Work must be completed within 180 days)
Applicant:
N JUSTIN & DANI ZWICK Phone: 402 - 910 -8248
ame.
Address: 15443 CHAD DR SE
YELM WA 98597
Property Information:
Site Address: 15443 CHAD DR SE Owner: JUSTIN ZWICK
Assessor Parcel No.: 41610018300 Subdivision: CHERRY MEADOWS Lot: 183
Contractor Information:
Name: PACIFIC AIR SYSTEMS Phone:
Address:
12811 PACIFIC HWY SW
LAKEWOOD WA 98499
Contractor License No.: PACIFAS093KA Expires:
Project Information:
Project: MECHANICAL
Description of Work: INSTALL 2.5 AIR CONDITIONER. DUCT TEST REQUIRED.
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
PACIFIC AIR SYSTEMS
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 WWaashin ton.
Siqnature / yv //� /� (L Uj!�%Lr l [ _� Date
Firm /% r C _ Fl
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Mm
(36 ) 458 -3244
REC #: 00200410 7/10/2015 1:34 PM
OPER: CO TERM: 001
REF #: 1555
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20150252 29.50CR
ZWICK, JUSTIN & DANI
15443 CHAD DR SE
MECH 29.50CR
TENDERED: 29.50 CHECK
APPLIED: 29.50 -
CHANGE: 0.00
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: Parcel #: 41610018300
Subdivisio
Lot #: Zoning;
I/ E
❑ New Construction ❑ Re -Model / Re -Roof / Addition ❑ Home Occupation Sign
❑ Plumbing 4( Mechanical ❑ Mobile / Manufactured Home Placement ❑ Other
Project Description /Scope of Work: Install 2.5 air conditioner
Project Value: $5049
Building Area (sq. ft) lSt Floor 2nd 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.
BUILDING OWNER NAME: Justin Zwick
ADDRESS 15443 Chad Dr SE EMAIL
CITY Yelm STATE Wa ZIP 98597 TELEPHONE 402 910 8248
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR PACIFIC AIR SYSTEMS TELEPHONE 253- 581 -5272
ADDRESS 12811 PACIFIC HWY SW EMAIL
CITY LAKEWOOD STATE WA ZIP 98499 FAX
CONTRACTOR'S LICENSE # PACIFAS093KA EXP DATE9/15 CITY LICENSE # 10572
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.
n
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Applicant's Signature e
Owner / Contractor / Owner's Agent / Contractor's Aaent (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
D
JUL 10 2015
105 Yelm Avenue West (360) 458 -3835
PO Box 479 (360) 458 -3144 FAX
Yelm, WA 98597 www.ci.yelm.wa.us