20160170 Permit Pkg 03212016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: ROBERT & ROBIN LEE
Address: 10806 UMTANUM ST SE
YELM WA 98597
Property Information:
Site Address: 10806 11MTANl1M ST SE
Assessor Parcel No.: 32640001800 Subdivision:
Contractor Information:
Name: ROBERT & ROBIN LEE
Address:
10806 UMTANUM ST SE
YELM WA 98597
Contractor License No.:
Permit No.: 20160170
Issue Date: 3/21/2016
(Work must be completed within 180 days)
Phone.
Owner: ROBERT LEE
Phone:
Expires: 0 /00 /0000
Project Information:
Project: MECHANICAL
Description of Work: REPLACE GAS HOT WATER TANK
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
ROBERT & ROBIN LEE
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 St of Washin ton.
Signature Date
Firm
Lot:
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Yelm
(36 ) 458 -3244
REC #: 00226179 3/21,/2016 9:04 AM
OPER: CO TERM: 001
REF #: 5446
PAID BY:
TRAN: 33.0000 BUILDING PERMIT'S
20160170 29.50CR
LEE, ROBERT & ROBIN
10806 UMTANUM ST SE
MECH 29.50CR
TENDERED: 29.50 CHECK
APPLIED: 29.50-
CHANGE: 0.00
PJ(dl70
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: ./J)20(` i1�W1�1/ Parcel #:
Subdivision: Lot #: Plan #: Zoning:
New Construction Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing 1` Mechanical Mobile / Manufactured Home Placement -7� Other
Project Description/Scope of Work:
Project Value:
Building Area (sq. ft) 1St Floor 2 d Floor Garage Deck
Basement Carport Patio
# Bedrooms # Bathrooms_ Heating: GAS /OTHER 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 MAIL
CITY( ► STATE WR ZIP qgS 2_7 TELEPHON Ej� -
L
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR /' TELEPHONE -5
ADDRESS /I EMAIL
CITY STATE WAZIP FAX
CONTRACTOR'S LICENSE #RL1�u�Df S+"74t DATE CITY LICENSE #
a
PLUMBING CONTRACTOR 15 —(.l ye_ o I ELLFINUNt �E7U
ADDRESS o EMAIL
CITY; N i.liu STATE_L,.�AZIP 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 property will be in accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
Applicant's Signature Date
Owner / Contractor I 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
Yelm, WA 98597
www.ci.yelm.wa.us
(360) 458 -3835
(360) 458 -3144 FAX