20160120 Permit Pkg 02012016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: YELM PRAIRIE CHRISTIAN
Address: P.O. BOX 578
YELM WA 98597
Property Information:
Site Address: 501 103RD AVE NE
Assessor Parcel No.: 64303601802
Subdivision
Permit No.: 20160120
Issue Date: 2/01/2016
(Work must be completed within 180 days)
Phone: 360- 458 -7564
Owner: YELM PRAIRIE CHRISTIAN
MCKENNA IRRIGATED Lot: 2
TRACTS
Contractor Information:
Name: YELM PRAIRIE CHRISTIAN Phone:
Address:
P.O. BOX 578
YELM WA 98597
Contractor License No.: Expires: 0 /00 /0000
Project Information:
Project: MECHANICAL
Description of Work: REPLACE AIR CONDITIONER FOR LIKE
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
YELM PRAIRIE CHRISTIAN
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 j� �e Date /— / /,
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Yolm
(36 ) 458 -3244
REC #: 00220888 2/01/2016 2 :03 PM
OPER: CO TERM: 001
REF #:
PAID BY:
ACCT #: XXXXXXXXXXXXXXXXXXX
AUTH #: 020317
TRAN #: 000000004813
TRAN: 33.0000 BUILDING PERMITS
20160120 29 , 5(CR
YELM PRAIRIE CHRISTIAN
501 103RD AVE NE
MECH 29.5(CR
TENDERED: 29.50 CREDIT CARD
APPLIED: 29.50-
CHANGE: 0.00
CITY OF YELM 2 01 `°
COMMERCIAL B ILDING PERMIT APPLICATION FORM
Project Address: Parcel #:
Zoning; Current Use: Proposed Use:
New Construction Re -Model / Re -Roof / Tenant Improvement
Plumbing v` echanical ❑ Fire Prevent/Suppress /Alarm Other
Project Description /Scope of Work:
Project Value:jO,
Building Area (sq. ft) Parking Garage 1St Floor 2nd Floor 3rd Floor
Building Height
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER/TENANT AME:
ADDRESS 477 ! V EMAIL
CITY STATE ZIP 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 CONTRACTO TELEPHONE
ADDRESS ' � EMAIL2z
CITY STATE k,,X ZIP/ FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Copy of City Mitigation documentation JFC).
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.
Date
(Please circle one.)
by such permit is not begun
f a period of 180 days
gK
F✓'i -yIr6- hwi
(360) 458 -3835
(360) 458 -3144 FAX
www.ei.yelm.wa.us
(dam