20150286 Permit Pkg 09082015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: JOHN /JANE PYANOWSKI
Address: 15334 104TH AVE SE
YELM WA 98597
Property Information:
Site Address: 15334 104TH AVE SE
Assessor Parcel No.: 62320004600
Contractor Information:
Name: KLIEMANN BROS.
Address:
4703 116TH ST. E
TACOMA WA 98446
Contractor License No.: 10407
Project Information:
Project: MECHANICAL
Description of Work:
Sq. Ft. per floor:
First
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Subdivision:
Permit No.: 20150286
Issue Date: 9/08/2015
(Work must be completed within 180 days)
Phone: 360- 400 -5385
Owner: JOHN PYANOWSKI
Phone:
Expires: 12/31/2015
Heat Type (Electric, Gas, Other):
Contractor
KLIEMANN BROS.
TOTAL FEES:
Applicant's Affidavit:
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 T ate of Washi .
Signature J �'`'t��i Date
Firm I ( 0 W1 be ✓r l?- �r,—
Lot:
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City �f Mm
(36 } 458 -3244
REC #: 00206200 9/08/2015 2:29 PM
OPER: CO TERM: 001
REF #: 52235
PAID BY:
IRAN: 33.0000 BUILDING PERMITS
20150286 29.50CR
PYANOWSKI, JOHN /JANE
15334 104TH AVE SE
MECH 29.50CR
TENDERED: 29.50 CHECK
APPLIED: 29.50-
CHANGE: 0.00
CITY OF YELM��'�
RESIDENTI L BUILDING PERMIT APPLICATION FORM
Project Address: 6334 Parcel #: 6232000 T��d
Subdivision: - W 1 1$K Lot #:_ Plan #: w-ww�'_ Zoning: r�. F
❑ New Construction ❑ Re -Model / Re -Roof / Addition ❑ Home Occupation Sign
❑ Plumbing mechanical e� ❑Mobile / Manufactured Home Placement ❑ Other
Project Description /Scope of Work: —
Project Value:
Building Area (sq. ft) 1St Floor ,--'2 "d Floor � 3`d Floor --Garage -2 car 3 carte^
Covered Patio •-,— Covered Porch wa-- Patio •— Deck .•.r
# Bedrooms. # Bathrooms_,ge'-- 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.
ADDRESS e44 �� r EMAIL _
CITY STATE ZIP TELEPHON
ADDRESS
CITY STA
ADDRESS
CITY STA
CONTRACTOR'S LICENSE
ADDRESS
CITY
CONTRACTOR'S LI
STA
LICENSE #_
EMAIL
TELEPHON
TELEPHON
EMAIL
Ip FAX
EXP DATE—CITY LICENSE #
TELEPHONE
EMAIL
IP FAX
EXP DATE—CITY LICENSE #
MECHANICAL CONTRACT R S TELEPHONE Z51:1 `01. l -1210»
ADDRE O I 'fh EMAIL
CITY STAT E_ZI P Q $f FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Copy of mitigation agreement with Ye 7m tom m pity tcliools, if applicable.
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.
App Icant' Date
O Contracto wner's Age ontractor's Agen ease circle one.)
All permits are n- 'oi= transferable and wi 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
105 Yelm Avenue West
Yelm, WA 98597
www.ci.yelm.wa.us
�_- CEIVED
SEP 0 8 2015
(360) 458 -3835
(360) 458 -3144 FAX
Google earth meters 200 70
1533 {. lo'er�-"SE
F-MK ivvpm (4 (p)