20150311 Permit Pkg 10122015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: RENEE COTTRIEL
Address: 16239 PRAIRIE HITS ST SE
YELM WA 98597
Property Information:
Site Address: 16239 PRAIRIE HTS ST SE
Assessor Parcel No.:
Contractor Information:
Name: BLACK HILLS, INC
Address:
1003 85TH AVE SE
OLYMPIA WA 98501
Contractor License No.: 10091
Subdivision:
Permit No.: 20150311
Issue Date: 10/1212015
(Work must be completed within 180 days)
Phone: 253 - 677 -8579
Owner: RENEE COTTRIEL
Phone:
Expires: 12/31/2015
Project Information:
Project: MECHANICAL
Description of Work:
REPLACE GAS FURNACE. DUCK LEAKAGE TEST REQUIRE.
Sq. Ft. per floor:
Heat Type (Electric, Gas, Other):
First
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 contractor, I further certify that I am currently
registered in the State of Washington.
Signatur Date is
Firm
Lot:
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
(l 015$e Im44
36�)
REC #: 00209711 100122015 3:30 PM
OPER: CO
REF #: 16528
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20150311
COTTRIEL, RENEE
16239 PRAIRIE H29 T SE
MECH
TENDERED: 29.50 CHECK
APPLIED: 29'50 -
CHANGE: 0.00
a1s030
CITY OF YELM
RESIDENTIAL BUILDING PETS PLICATION FORM
Project Address:I �� (�.� "Parcel #:Q�'1a06a�kdb
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
Project Value: S `- e to
Building Area (sq. ft) 1s' Floor 2nd Floor 3`d 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?
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAVE:
ADDRESS F EMAIL
CITY Q4,Qm STATEWA IP TELEPHONE 3L o
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 CONTRACT(
ADDRESS IOLA '36j'-01 a�
CITY�STA'
CONTRA( OR'S LICENSE
TELEPHON
EMAIL
DATE
Copy of mitigation agreement with Yelm Community
CITY LICENSE #�
iools, 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
Citv of Yelm.
1 '
Ap'p Icant'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
105 Yelm Avenue West (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.velm.wa.us