20160210 Permit Pkg 0552016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: GARY TRUELOVE
Address: 14822 99TH AVE SE
YELM WA 98597
Property Information:
Site Address: 14822 99TH AVE SE
Assessor Parcel No.: 78640018000
Contractor Information:
Name: B -LINE PLUMBING
Address:
12911 OLD HWY 99 SE
TENINO WA 98589
Contractor License No.: BLINEPL87ONB
Permit No.: 20160210
Issue Date: 5/05/2016
(Work must be completed within 180 days)
Phone: 360- 400 -0413
Owner:
Subdivision: TAHOMA TERRA Lot: 180
Project Information:
Project: MECHANICAL
Description of Work.
REPLACE WATER HEATER
Sq. Ft. per floor:
First
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Phone:
Expires: 7/31/2016
Heat Type (Electric, Gas, Other):
Contractor
B -LINE PLUMBING
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 Std E of Washington.
Signatu Date 6' S - kj
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Mm
(36 ) 458 -3244
REC #: 00230299 5/05/2016 8:57 AM
OPER: CO TERM: 001
REF #: 5498
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20160210 29.5GCR
TRUELOVE, GARY
14822 99TH AVE SE
MECH 29.5(,CR
TENDERED: 29.50 (HECK
APPLIED: 29.50-
CHANGE: 0.00
Zo1 (p oZ/o
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: IyBZ2 9c � `` n\)e 5E
Subdivision: Lot #
Parcel #: -]gyp q M 1 2� 00 Qj"
Plan #: _ Zoning:
New Construction Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing K Mechanical Mobile / Manufactured Home Placement Other
Project Description /Scope of Work: reyo --_Q .(' ( eetA eP
Project Val
Building Area (sq. ft) Vt Floor 2nd 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: cx ti oNi-q- _
ADDRESS Iq$2Z 'q _-) S C— EMAIL
CITY_': STATEv,3 ZIPC\�5ck TELEPHONE NZS 22,1 1
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 $ -ht`s Plom c nc'1 TELEPHONE r i
ADDRESS'2Cj\ 6\6 _ EMAIL Q[yg -Corr)
CITY 7kn \r)O STATE ZIP 1K5n, FAX 3(_oQZts.c\0405'
CONTRACTOR'S LICENSE #ZU NQPC62 D EXP DATEJJj4CITY 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.
QL;:-,z
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 (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
wwwxLyelm.wa.us