20150226 Permit Pkg 07212015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: EVALONNIE SAN NICOLAS
Address: 9023 ANDES CT SE
YELM WA 98597
Property Information:
Site Address: 1AR19 DDAIDIG VICTA 1 D CC
Assessor Parcel No.:
Contractor Information:
Name: SUNSET AIR INC
Address: TERRY MEDLOCK
5210 LACEY BLVD.
LACEY WA 98503
Contractor License No.: 10734
Project Information:
Project: MECHANICAL
Description of Work:
INSTALL AC UNIT
Sq. Ft. per floor:
First
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Subdivision:
Permit No.: 20150226
Issue Date: 0 /00 /0000 7141,2v)
(Work must be completed within T80 days)
Phone: 360- 458 -7275
Owner: REGINA YAMAGUSHI
Phone:
Expires: 12/31/2015
Heat Type (Electric, Gas, Other):
Contractor
SUNSET AIR 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 rests ions f%ffpcord. If applying as a contractor, I further certify that I am currently
registered in the S to f ington.
Signature Date ;7 S
Firm � `4
Lot:
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Yelm
(36 ) 458-3244
REC #: 00201956 7/21/2015 3:09 PM
OPER: CO TERM: 001
REF #: 34969
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20150222
REGAN, TIMMY & SHERRY
14732 91ST AVE SE
MECH 29,50CR
TRAN: 33.0000 BUILDING G ERMITS
20150226
SAN NICOLAS, EVALONNIE
14812 PRAIRIE VISTA LP SE
MECH 29.50CR
TENDERED: 59.00 CHECK
APPLIED: 59.00 -
CHANGE: 0,00
JUN /13/2015/SAT 02:57 PM Sunset Air FAX No.360 456 4990 P.002
CITY OF YELM���
QRESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: �� o ea r�� y,6 y Lr'f— Parcel #:
Subdivision: — Lot #: Plan #: Zoning:
C New Construction E Re. -Model / Re -Roof /Addition ❑ Home Occupation Sign
G Plumbing 'Mechanical ❑ _Mobile / Manufactured Home Placement ❑ Other
Project Description /Scope of Work--V (� n h-
P(C(va c-d
Project Value: "I 045
Building Area (sq. ft) 15t Floor 2f' Floor 3rd 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?
byes, a completed environmental checklist must accompany permit application.
LICENSE #
ADDRESS EMAIL
CITY STATE /—ZIP TELEPHONE
TELEPHONE
ADD S EMAIL
CITY STATE ZIP FAX
CONTRACT S LICENSE # EXP DATE CITY LICENSE #
TELEPHONE_
ADDRESS EMAIL
CITY STATE ZIP FAX _
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE # ^ ~�
Q i -TELEPH(g E
ADDRESS V EMAIL Y f
CITY W, S ATE ZIP J FAX -1 d U
CONTRACT R'S LICENSE # " EX DATE 'ITY LICENSE # IDI L
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby certify that the above Informatlon Is correct and that the construction on, and the occupancy and the use of the
abov escribed property will be in accordance with the laws, rules and regulations of the State of Washington and the
CI of elm,
Applicant's Si nature Date
Owner I Contractor / Owner's Agent I 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 clays
105 1'elm Auenzxe West J N l (360) 4583835
Yelm, WA 93591 (860) 458- 8144FAX
wxow.ci.yelm,wa.us