20160106 Permit Pkg 01252016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: SUNSET AIR INC
Address: 5210 LACEY BLVD. SE
LACEY WA 98503
Property Information:
Site Address: smst I1=GG1=RCr1A1 AVP AIW
Assessor Parcel No.:
Contractor Information:
Name: SUNSET AIR INC
Address: TERRY MEDLOCK
5210 LACEY BLVD.
LACEY WA 98503
Contractor License No.: 10734
Subdivision:
Permit No.: 201 60106
Issue Date: 1/25/2016
(Work must be completed within 180 days)
Phone: 360- 456 -4956
Owner: DARLENE BAKER
Phone:
Expires: 12/31/2015
Project Information:
Project: MECHANICAL
Description of Work: GAS FURNACE3 CHANGE OUT. DUCT LEAKAGE TEST REQUIRED
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
SUNSET AIR INC
TOTAL FEES:
Applicant's Affidavit:
I certify tha have read and examined the information contained within the application and know the same
Ito be true nd correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regutin on hose governing zoning and land subdivision, and in addition, all covenants,
easement n estrictions of record. If applying as a contractor, I further certify that I am currently
registered t e'State of ashington.
Signature C Date
Firm �0 .t-- at V `
Lot:
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Mi
(36 ) 458 -3244
REC #: 00220254 1/25/2016 11:39 AM
OPER: CO TERM: 001
REF #: 35214
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20160106 29.5(CR
SUNSET AIR INC
508 JEFFERSON AVE NU
MECH 29.5(CR
TENDERED: 29.50 (HECK
APPLIED: 29.50-
CHANGE: 0.00
2_0 b 0 to 6
CITY OF YELM E a(,2 Uo
,7RESID,,EENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: �� 0� Pf� 6 j'i(- J Parcel #: ��i "l ��ad2i)
Subdivision: Lot #: Plan #: Zoning:
New Construction H Re -Model / Re -Roof / Addition H Home Occupation Sign
❑ Plumbing Mechanical r-H Mobile / Manufactured Home Placement H Other
Project Description /Scope of Work: �! �( -S � V o 4 C,� h Pt l7 ocl
Project Value: -i30
Building Area (sq. ft) 1st Floor 2nd Floor 3d Floor Garage -2 car 3 car
Covered patio Covered Porch Patio Deck
# Bedrooms # Bathrooms_ Heating: GASIOTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
If yes, a completed environmental checklist must accompany permit application.
ADDR SS EMAIL
CITY STATE Lk) ZIP ` TELEPf LONE
LICENSE #
ADDRESS EMAIL
CITY TATS ZIP TELEPHONE
a, W TELEPHONE
ADDRESS EMAIL
CITY —STATE ZIP FAX
CONTRACTOR'S LICENSE # \ EXP DATE CITY LICENSE #
TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
_ 1 D.I r Al Wit- TELEPHONE p q5(�'
ADDRESS 1199,10 _ V 5 r EMAIL
CITY �R'S S ATE L\)a_ ZIP SU'� FAX
CONTRSE #fi t LWi 1d 2J2LVkXP DATE CITY LICENSE #
.15111
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I heNby�ertify that the above information is correct and that the construction on, and the occupancy and the use of the
a)i6ve des ribed property will be in accordance with the laws, rules and regulations of the State of Washington and the
City of YeI
Applicant's Signature Date
Owner I Contractor 1 Owner's Agent I 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
i0"
2TS
105 Yelm Avenue West p Y. -(3G0} 458 -3835
Yelm, W!1 98597 L7 (360) 458 -3835
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