20160100 Permit Pkg 01062016City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458 -3144
Applicant:
Name: DARRELL & MICHE JOHNSTON
Address: PO BOX 629
YELM WA 98597
Property Information:
Site Address: lr%?in innTlu AVG c11=
Assessor Parcel No.: 51110000400
Contractor Information:
Name: DARRELL & MICHE JOHNSTON
Address:
PO BOX 629
YELM WA 98597
Contractor License No.:
Permit No.: 20160100
Issue Date: 1/06/2016
(Work must be completed within 180 days)
Phone: 360- 400 -1078
Owner: DARRELL JOHNSTON
Subdivision: GOLF COURSE VIEW Lot: 4
ESTATES
Phone:
Expires: 0 /00 /0000
Project Information:
Project: MECHANICAL
Description of Work: INSTALL PELLET STOVE AND VENTING
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
DARRELL & MICHE JOHNSTON
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 Washington.
Signature Date 1
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Mm
(36 ) 458 -3244
REC #: 00217915 1/06/2016 8 :54 AM
OPER: CO TERM: 001
REF #:
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20160100 29.5C;CR
JOHNSTON, DARRELL & MICHE
15220 100TH AVE SE
MECH 29.56CR
TENDERED: 40.00 CASH
APPLIED: 29.50-
CHANGE: 10.50
CITY OF YELM D mumlcyml
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
L
Project Address: ,Zzp lC � 1Se� J � Parcel #:
Subdivision: Lot #: Plan #: Zoning: B Y: --------------------
i New Construction. i i Re -Model / Re -Roof / Addition Home Occupation Sign
i Plumbing }Mechanical i i Mobile / 1
Manufactured Home Placement n i i Other
Project Description /Scope of Work: :7—AfA � ` — � I QV e V&_'A' A
Project Value:�i
Building Area (sq. ft) 15t Floor 2nd Floor 3rd Floor Garage -2 car 3 car.
Covered Patio Covered Porch Patio Deck
# Bedrooms_ # Bathrooms_ Heating: GA THE 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:
ADDRESS U 0, EMAIL e-Lk_ f 4. 1, cc y,C�x�
CITY I LvJ STATE L - ZIP e TELEPHONE /,,,I —1 Q7 7
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 TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the
above described pr y will be in accordance with the laws, rules and regulations of the State of Washington and the
City of Yeln ,
AppT's Signature Date
Owner / Contractor / Owner's Agent / 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
www.ci.yelm.wa.us
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