20150320 Permit Pkg 10262015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: PAYMASTER ZAAL & JENNIFER
Address: 10157 TERRA VALLEY ST
YELM WA 98597
Property Information:
Site Address: 10157 TERRA VALLEY ST
Assessor Parcel No.: 8178000100 Subdivision:
Contractor Information:
Name: BLACK HILLS, INC
Address:
1003 85TH AVE SE
OLYMPIA WA 98501
Contractor License No.: 10091
Project Information:
Project: MECHANICAL
Description of Work:
Permit No.: 20150320
Issue Date: 10126/2015
(Work must be completed within 180 days)
Phone: 616 - 818 -9444
Owner: PAYMASTER ZAAL
TERRA VALLEY Lot: 1
Phone:
Expires: 12/31/2015
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
PAYMASTER ZAAL & JENNIFER
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 Washin
Signature Date
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
(3 of 5 e3m44
t AM
REM 00211206
10/26/2015 10:26
QPER.. CO TERM: 001
REF #: 16557
PAID BY
IRAN:
33.0000 BUILDING 50CRIT5
20150320 PAYMASTER
ZAAL &JENNIFER,
10157 TERRA VALE 5 T
MECH
TENDERED: 29.50 CHECK
APPLIED: 29.50-
__-- - --0. 00
CHANGE:
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: l ok 6l l rrn,_ V (&� S Parcel #: '43-11 T o m l o o
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:
Uqw + W_rV'
Building Area (sq. ft) 1s` Floor 2nd Floor 3`d Floor Garage -2 car 3 car
Covered Patio Covered Porch Patio Deck
M
# 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: wriky
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE - a
ARCHITECT /ENGINEER - --' LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONT'RACTOR'S LICENSE # EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CON CTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTC
ADDRESS 10h-2) Ar
CITY M w _STA
CONTRAC O 'S LICENSE
TELEPHON
EMAIL
_F
DA_
Copy of mitigation agreement with Yelm Community
CITY LICENSE # -U if • 0
fools, 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
City of Yelm.
-�>Y� Lo(n �61Q_ce_ks-
Applic_ant'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