20160173 Permit Pkg 03222016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: ROSALIE L. THEROUX
Address: 1202 THURSTON CT NW
YELM WA 98597
Property Information:
Site Address: 1202 THURSTON CT NW
Assessor Parcel No.: Subdivision:
Contractor Information:
Name: FAST WATER HEATER
Address:
11715 NORTH CREEK PARKWAY S.
BOTHELL WA 98011
Contractor License No.: FASTWWH948BC Expires
Permit No.: 20160173
Issue Date: 3/22/2016
(Work must be completed within 180 days)
Phone: 360- 458 -1936
Owner: ROSALIE THEROUX
Lot:
Phone: 425- 814 -3124
1/04/2014
Project Information:
Project: MECHANICAL
Description of Work: REMOVE—REPLACE GAS WATER HEATER
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
FAST WATER HEATER
TOTAL FEES:
Applic is Affidavit:
I certify that I have read and examined the information contained within the application and know the same
to be tr a and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm r gulatigpsrwh udin those governing zoning and land subdivision, and in addition, all covenants,
ease m nts and restriction of record. If pplying as a contractor, I further certify that I am currently
registe dint a State of ashington ^ ^
Signatu {1� Date
Firm
t _ �. � - ��_ •
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cl` a458�3m44
(36�)
3/22/2016
OPER: 4:45 PM
REC #: 00226414 ERM;
CO 001
REF #: 20665
PAID BY
TRAN; 33.0000 BUILDING P[RMITS
20160173
TWEROUX, ROSALIE L.
1202 THURSTON C�9 5(iCR
MECH
TENDERED: 29,50 CHECK
APPLIED: 29,50-
CHANGE:
0,00
IY I C/1- C�4
CITY OF YELM ` � 3 1
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: ��CJ� 1 �� � I'Sl �' C-1 Parcel #: 5 � � 7 C) C) �� ZO� � b �
Subdivision
Lot #:�_ Plan #:
Zoning: —
New Construction Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing Mechanical Mobile / Manufactured Home Placement Otherr I,�
Project Description /Scope of Work: S a er- ' "��
Project Value: 4 1 y I P
Building Area (sq. ft) 1St Floor 2nd Floor 3rd Floor Garage -2 car 3 car
Covered Patio Covered Porch Patio Deck
# Bedrooms # Bathrooms Heatin OGAS/ TH ER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? �J d
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: COSA U�l 1:
ADDRESS Tb C-F ,Q EMAIL
CITY LYVi STATE ✓ ZIP TELEPHONE 3 (G �'/�?� 1
E#
ADDRESS AIL
CITY STATE ZIP TELEPH
ADDRESS
EMAIL
CITY TE
ZIP
C R'S LICENSE #
EXP DATE NSE #
PLUMBING C
TELEPHONE
ADDRESS
VA
CITY STATE
ZIP
FAX
C CTOR'S LICENSE #
EXP DATE CITY LICENSE #�--
MECHANICAL CONTRACTOR f
ASL W
TELEPHONE g
ADDRESS 1
S
C EMAIL
CITY 6 /I P[ 1 STATE
ZIP
D I I FAX
CONTRACTOR'S LICENSE #fASTWW+1gL1X3 C EXP DATE CITY LICENSE #
I -H_0Copy of mitigation agreement with Yelm Community chools, 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�2�Qz 02��Z� 3 - 7_ — 1 (_,,�7_
Applicant's Signature Date
Owner I 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 17e t "T
105 Yelm Avenue West •(fi'BOj "458 -38"f3 "'
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.yelm.wa.us