20150328 Permit Pkg 11102015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: SANDRA ROSEBERRY
Address: 15120 CARTER LP SE
YELM WA 98597
Property Information:
Site Address: 1-1;17f1 rAPTFP I P AF
Permit No.: 20150328
Issue Date: 11110/2015
(Work must be completed within 180 days)
Phone: 360- 451 -6705
Owner: SANDRA ROSEBERRY
Assessor Parcel No.: 52920003500 Subdivision: HAWK LANDING Lot: 35
Contractor Information:
Name: BRENNAN HEATING
Address:
4601 S 134TH PL
SEATTLE WA 98168
Contractor License No.: 10111 Expires
Phone:
12/31/2015
Project Information:
Project: MECHANICAL
Description of Work: CHANGE OUT GAS FURNACE AND WATER HEATER. DUCK LEAKAGE TEST REQUIRED.
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
BRENNAN HEATING
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.
Signature Date
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Tof Yell
) 458 -3244
REC#: 00212687
OPER : CO 11/10/2015 9 :47 AM
PER
REF #: 43294 TERM: 001
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20150328 29.50CR
RIIEBERRY, SANDRA
15120 CARTER LP SE
MECH 29.50CR
TENDERED: 29.50 CHECK
APPLIED: 29.50-
CHANGE: 0.00
CITY OF YELM
r1RESIDENTIAL BUILDING PERMIT APPLICATIO�Nl FORM
Project Address:/ 5] d. C(A�, r L Parcel #:
Subdivision: Lot #: Plan #: Zoning:
New Construction - / Re -Roof / Addition J Home Occupation Sign
Plumbino (Mechanical ❑ Mobile / Manufactured Home Placement -1 Other
Project
Project
Building Area (sq. ft) 151 Floor 2nd Floor Garage Deck
Basement Carport Patio
# 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: �� r, r o� o a s f r
ADDRESS 2�,.� EMAIL
CITY STATE ZIP TELEPHONE 2,lo 0 �S 1 Lo DS
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 #
r
MECHANICAL CONTRACTOR C vim + r TELEPHONE 9D
ADDRESS � O 1 S 13 k L EMAIL 0. )2\ 4L a tic wr`� n
CITY �u �� STATED, 1 - .ZI � FAX o� • ay `v Q S
CONTRACTOR'S LICENSE aq'gl P DATE CITY LICENSE #
U a a rs
Copy of mitigation agreement with Yelm Community choo s, if applicable.
.4 cert4 that the above information is correct and that the construction on, and the occupancy and the use of the
se described property will be in accordance with the laws, rules and regulations of the State of Washington and the
of Yelm �) f
' ant's Signature Date
er / Contractor ! Owner's Agent 1 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
Wu)w.6.ye1m.wa.u8
NOV 0 9 2015
cA rY,