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20160109 Permit Pkg 01192016
City of Yelm Community Development Department Building Division Phone: (360) 458 -8407 Fax: (360) 458 -3144 Applicant: Name: HOME TOWN PROPERTY Address: 1600 4TH AVE E OLYMPIA WA 98506 Property Information: Site Address: 204 YELM AVE E Assessor Parcel No.: 64400701500 Subdivision: Contractor Information: Name: HOME TOWN PROPERTY Address: 1600 4TH AVE E OLYMPIA WA 98506 Contractor License No.: Permit No.: 20160109 Issue Date: 1/19/2016 (Work must be completed within 180 days) Phone: 360- 456 -7368 Owner: Lot: Phone: Expires: 0 /00 /0000 Project Information: Project: MECHANICAL Description of Work: INSTALLATION OF DUCTLESS HEAT PUMP Sq. Ft. per floor: First Heat Type (Electric, Gas, Other): Second Third Garage Basement Fees: Item MECHANICAL Contractor HOME TOWN PROPERTY 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 includin those verning zoning and land subdivision, and in addition, all covenants, easements and restri i s of r rd. If applying as a contractor, I further certify that I am currently registered in the St f Was gton. ------ ---- -- Al, ature nn- - >>>�y� Date — l �– l r / Fees $ 29.50 $ 29.50 OFFICIAL USE ONLY # Sets of Prints: Final Inspection: Date: By: CITY OF YELM COMMERCIAL BUILDING PERMIT APPLICATION FORM Project Address:,,�,bq C V 1- �' Y Parcel #: Zoning; Current Use: Proposed Use: ❑ New Construction ❑ Re -Model / Re -Roof / Tenant Improvement Plumbing X< Mechanical ❑ Fire Prevent/Suppress /Alarm ❑ Other Project Description /Scope of Work: L!2w) f 9 Project Value: Building Area (sq. ft) Parking Garage Building Height Ils' Floor 2nd Floor 3rd Floor Are there any environmentally sensitive areas located on the parcel ?_ If yes, a completed environmental checklist must accompany permit application. BUILDING OWNER/TENANT NAME: ° ADDRESS G ©0 4 }-� EMAIL CITY G 1STATE_L,�)ZIP 1"6(, TELEPHONE 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 CONTRACTOR C� �' TELEPHONE_ __a ),q 3 L)_ 9E ADDRESS_ EMAIL & 9 WI - f, .4y 1 L-2!�j A STATE CONTR C OR'S LICENSE #a )dr -A-K * EXP DATE 4e_CITY LICENSE # 1C-24 Copy of City Mitigation documentation 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 ill be in accordance with the laws, rules and regulations of the State of Washington and the City of Yelm. 11) /7 Applicant''; sire Owner / ontract r f Owner's Agent / Contractor's Agent / Tenant /-- /q -lE Date (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 Ave W Yelm, WA 98597 (360) 458 -3835 (360) 458 -3144 FAX www.ci.yelm.wa.us