20150254 Permit Pkg 07152015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: F. /HACKER DOYLE
Address: 14949 105TH AVE SE
YELM WA 98597
Property Information:
Site Address: 14949 105TH AVE SE
Assessor Parcel No.: 65080002700 Subdivision
Contractor Information:
Name: BLACK HILLS, INC
Address:
1003 85TH AVE SE
OLYMPIA WA 98501
Contractor License No.: Expires
Permit No.: 20150254
Issue Date: 7/15/2015
(Work must be completed within 180 days)
Phone:
Owner: FAITH DOYLE
Phone: 705 -8590
Project Information:
Project: MECHANICAL
Description of Work: REPLACE FURNACE AND HEAT PUMP. DUCT TEST 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 contractgr, I further certify that I am currently
registered in the State of Washi gton.
Signature, = ��� Date U �f
Lot:
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City �f Vi
(36) 458 -3244
REC #: 00201182 7/15/2015 10:55 AM
OPER: CO TERM: 001
REF #: 16246
PAID BY:
TRAN: 33,0000 BUILDING PERMITS
20150254 29.50CR
DOYLE, F. /HACKER
14949 105TH AVE SE
MECH 29.50CR
TENDERED: 29.50 CHECK
APPLIED: 29.50-
CHANGE: 0.00
CITY OF YELM
r RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: I qQ Q 105 "St_ Parcel #: 6iso 90M 2- [Qd
Subdivision: Lot #: Plan #: Zoning:
❑ New Construction Re -Model / Re -Roof / Addition Home Occupation Sign
❑ Plumbing ..Mechanical Mobile / Manufactured Home Placement Other
Project Description /Scope of Work: t Q--
Project Value: 1% I o0o
Building Area (sq. ft) 15' Floor 2nd Floor 3`d Floor -
Covered Patio Covered Porch Patio
Garage -2 car 3 car.
Deck
# 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:
ADDRESS K - EMAIL
CITY STATE tJ_3FY ZIP �6 TELEPHONE - 310 - I
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 S TELEF
ADDRESS J 3 %�� re- EMAIL
CITY STATE ysly ZI %R51 _FAX_
CONTRA OR'S LICENSE #fly{ kl 1LEXP DATE-
-7 Lt a�
Copy of mitigation agreement with Yelm Community
CITY LICENSE #
Is, if applicable.
U
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.
Applicant's Signature Date
Owner / Contractor / Owner's Agent / Contractor's Agent (Please circle one.)
i
114 /g
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
IV ED
J U L 15 2015
105 Yelm Avenue West (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.yelm.wa.us