20150243 Permit Pkg 07132015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: NORTHWEST FAMILY HOMES
Address: PO BOX 39
EAST OLYMPIA WA 98540
Property Information:
Site Address: 14702 91ST AVE SE
Assessor Parcel No.: 33860000100
Contractor Information:
Name: NORTHWEST FAMILY HOMES
Address:
PO BOX 39
EAST OLYMPIA WA 98540
Contractor License No.: NORTHFH954BE
Project Information:
Project: NEW RESIDENTIAL BUILDING
Description of Work: LOT 1, PLAN 2145
Sq. Ft. per floor: First 795
Second 1350
Third
Garage 397
Basement
Fees:
Item
NEW RESIDENTIAL BUILDING
MECHANICAL
PLUMBING
Subdivision
Permit No.: 20150243
Issue Date: 7/13/2015
(Work must be completed within 180 days)
Phone: 360- 791 -5644
Owner: NORTHWEST FAMILY HOMES
BELLA HOUSA VILLAGE Lot: 1
Phone:
Expires: 1/05/2017
Heat Type (Electric, Gas, Other): GAS
Contractor
NORTHWEST FAMILY HOMES
SUNSET AIR INC
ACME PLUMBING
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 �Statepf Wa iing711 i s"3
Fees
$17,114.67
$ 78.25
$ 111.00
$ 17,303.92
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Citt of Mm
(36 ) 458 -3244
REC #: 00200629 7/13/2015 12:17 PM
OPER: CO TERM: 001
REF #: 15231
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20150243 17,303.92CR
NORTHWEST FAMILY HOMES
14702 91ST AVE SE
BLD -RES1 17,114.67CR
MECH 78.25CR
PL 111.000R
TRAN: 33.0000 BUILDING PERMITS
20150241 17,365.14CR
NORTHWEST FAMILY HOMES
14721 91ST AVE SE
BLD -RES1 17,162.39CR
MECH 84.75CR
PL 118.00CR
TENDERED: 34,669.06 CHECK
APPLIED: 34,669,06-
CHANGE: 0.00
YELM COMMUNITY SCHOOLS
PO BOX 476
YELM WA 98597
Receipt #: 308650 Clerk: Gerber
Manual #: Terminal: 1
7/13/2015 12:13 PM
NNW FAMILY HOMES
NNW FAMILY HOMES
NORTHWEST, FAMILY HOMES
7426 MANZANITA DR NW
OLYMPIA, WA 98502
Qty Item Price
1 CPF MITIGATION 3015.00
MITIGATION
Lot 1 Bella Housa Village 14702 91st
Ave
1 CPF MITIGATION 3015.00
MITIGATION
Lot 49 - 14921 91st Ave SE
Subtotal
6030.00
Tax
0.00
Total
6030.00
Debit /Credit 6030.00
Change Due 0.00
THANK YOU
�.o1s�z�
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address:_ i4 70) 4j rr Aw, M Parcel #; 3 .7 96 O ()u b
Subdivision:_ Bt:4L _ �}pul�: Lot #: Plan #: ? 111' Zoning;
,yKNew Construction i ; Re -Model / Re -Roof / Addition t ; Home Occupation Sign
i Plumbing i Mechanical a Mobile / Manufactured Home Placement Other
Project Description/Scope of Work: t!1' o 11 fVLL L �' t.:1 S ( OL
Project Value. _& ;Np
Building Area (sq. ft) 1St Floor 7g r 2nd Floor �(Q Garage 3 el 7 Deck
Basement Carport Patio +Ps,�it 61v4— of
#
Bedrooms--T # Bathrooms Z +(Y Heating: OOTHER 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 O}(VNER NAME:, +►r' (- �II,,c' j' �' j-sh vvt , r, ;y� f - - --
ADDRESS_
CITY rf J h STATE v�fi ZIP�,!�5��/� TELEPHONELtj - 7r- Si y`+j
ARCHITECT /ENGINEER
ADDRESS
CITY V l,,f. {t, STATE i :J .4 ZIP C3 fi �" t TFI 1= punniG
GENERAL CONTRACTOR)
ADDRESS_ 0.0 :4 3C'+
CITY ; ' j i STA
CONTRACTOR'S ICENSE
PLUMBING CONTRACTOR_
ADDRESS I -73 L Pi i i' L
CITY_ U 1,1 vH 0 e, STA
CONTRACTOR'S LICENSE
TELEPHONE .3 c�> A)f -
EMAIL 0;'6`GfLvi�,t
P F
y RE EXP DA
MECHANICAL CONTRACTOR.ftruye r Ah
ADDRESS_ S Zt O LtY c ��I CJ j Vi4
CITY �, �;� e STATE (.✓-f ZIP
CONTRACTOR'S LICENSE #I'6' /,;lEt# �Zc
CITY LICENSE #
i w TELEPHONE 3G i.' -
EMAIL
i ,13 FAX
EXP DATE CITY LICENSE #
TELEPH0NE_!tiZ� q--.f 1-
EMAIL
EXP DATE
CITY LICENSE #
Copy of mitigation agreement with Yelm Community Sch
if applicable.
Gx�r7 * t c;ff,j <h t
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.
t
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
/:3 —
105 .Yebn Avenue West
Yelm, WA 98597
www.ci.yelm.wa.res
JUN 17 2015
{360) 458- 3835 __.
(360) 458 -3144 FAX
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City Or Yelm, CDD
Approved