20160172 Permit Pkg 03222016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: DWIGHT /JEN LITTLEFIELD
Address: P.O. BOX 2943
YELM WA 98597
Property Information:
Site Address: 15625 105TH WAY SE
Assessor Parcel No.: 22730230100 Subdivision:
Contractor Information:
Name: FAST WATER HEATER
Address:
11715 NORTH CREEK PARKWAY S.
BOTHELL WA 98011
Contractor License No.: FASTWWH948BC
Permit No.: 201 60172
Issue Date: 3/22/2016
(Work must be completed within 180 days)
Phone:
Owner: DWIGHT LITTLEFIELD
Lot:
Phone: 425- 814 -3124
Expires: 1/04/2014
Project Information:
Project: PLUMBING
Description of Work: REMOVE—REPLACE ELECTRIC WATER HEATER
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
PLUMBING
Contractor
FAST WATER HEATER
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 triction of record. If applying as a contractor, I further certify that I am currently
registered in th tate of ashin o .
Signature Date 3'ZZ
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
(3 of 8e
3S44
(36 )
REC #: 00226415 3/22/2016 4:46 PM
DPER: CO TERM: 001
REF #: 20640
PAID BY:
TRAN: 33.0000 PERMITS
RMRITS
20160172
LITTLEFIELD, DWIGHI /JEN
15625 105TH WAY SE
PL 2
TENDERED: 29.50 CHECK
APPLIED: 29.50 -
CHANGE:
5 4 lv q 4 fJl i /1M V)
CITY OF YELM 1
RESIDENTIAL BUILDING PERMIT APPLICATION FORM ZCKDQ1 `7�L
1 � I NSTR IA/ s� �� � IM �� ��� i b�
Project Address: arcel #: V
Subdivision:
Lot #: Plan #: Zoning:
E New Construction Re -Model / Re -Roof /Addition i Home Occupation Sign
Plumbing Mechanical Mobile / Manufactured Home Placement EOther f �,
Project Description /Scope of Work: �P1/� V �/ I�� f �� eA`e o-r c, GUa� k1OA4—
Project Value: q V )
Building Area (sq. ft) 1St Floor 2nd Floor 3rd Floor Garage -2 car 3 car.
Covered Patio Covered Porch Patio Deck
# Bedrooms_ # Bathrooms_ Heating: GAS /OTHER ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? �J 0
/f yes, a completed environmental checklist must accompany permit application.
10-MM A
I . Em W4 - =__M , MOO
E#
ADDRESS AIL
CITY STATE ZIP TELEPH
R
ADDRESS EMAIL
CITY __-STATE ZIP
C
ONTRA
R'S LICENSE # EXP DATE NSE #
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.
V(\AtItA o � 9 - ,� cl - I �
Applicant'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
Yelm, WA 98597
www.ci.ye1m.wa.us
(360) 458 -3835
(360) 458 -3144 FAX
IrM