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20150341 Permit Pkg 12042015
City of Yelm Community Development Department Building Division Phone: (360) 458 -8407 Fax: (360) 458 -3144 Applicant: Name: KEVIN AND KIM SELLON Address: 14819 91 ST AVE SE YELM WA 98597 Property Information: Site Address: 14819 91 ST AVE SE Assessor Parcel No.: 33860004100 Contractor Information: Name: SUNSET AIR INC Address: TERRY MEDLOCK 5210 LACEY BLVD. LACEY WA 98503 Contractor License No.: 10734 Project Information: Project: MECHANICAL Description of Work: Sq. Ft. per floor: First Second Third Garage Basement Fees: Item MECHANICAL Subdivision Permit No.: 20150341 Issue Date: 12/04/2015 (Work must be completed within 180 days) Phone: 802 - 318 -6019 Owner: KIM SELLON BELLA HOUSA Phone: Expires: 12/31/2015 Heat Type (Electric, Gas, Other): Contractor SUNSET AIR 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 Washingto / Signature - " Date Z ""(' I C C Firm Lot: 41 Fees $ 29.50 $ 29.50 OFFICIAL USE ONLY # Sets of Prints: Final Inspection: Date: By: (6 o le3m44 (360i 03214384 12104/2015 REC #; TERM: 001 OPER � CO 154 REF# AID M ; 9 :13 AM P 53,0000 BUILDING PERMITS MN: 29.50 20150341 ON, KEVIN ANO KIM 14819 91ST AVE S2E9,50 MEW 29.50 CNECK TENDERED: 29 50- APPLIED: - --'' 0.00 CHANGE: I OLIW CITY OF YELM RESIDENTIAL BUILDING PERMIT APPLICATION FORM n� -py `r 33 Yjpfmt yluo Project Address: , � (� � vl� T 1 � Jri Parcel* Subdivision: Lot #: Plan #: Zoning: New Construction © Re -Model I Re -Roof 1 Addition ❑ Home Occupation Sign ❑ Plumbing —� Mechanical ❑ Mobile h /�/ Manufactured p Home Placement ❑ Other Project Description/Scope of Work: (�i�r - 6 rrt 111 Project Value: c�5 Building Area (sq. ft) 18t Floor 2nd Floor 3" 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. ADDRESS EMAIL CITY P Vt) STATE 62A--,ZIP TELEPHONE —LICENSE# ADDRESS EMAIL CITY STATE ZIP TELEPHONE 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 # l TELEPHONE 0' lP— ADDRESS5q,10 cla U 5 .. EMAIL I��YYi It�15( 111S.I"i J r l 0Y� M60 CITY SATE L ZIP FAX .ice 41::"(B__;_ CONTRACT R'S LICENSE #SJ 1x ��Z V1_XP DATE CITY LICENSE # Copy of mitigation agreement with Yelm Community Schools, if applicable. I hereby certify that the above infonnation is correct and that the construction on, and the occupancy and the use of the above d property will be In accordance with the laws, rules and regulations of the State of Washington and the City f Yelm. Applicant's Signaturb 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 105 Yelm Avenue West u L- U v to (360) 458 -3835 Yelm, WA 98589 (360) 458 -3144 FAX www.ci.yeim.wa.us