20160183 Permit Pkg 04072016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: JODI /ANDREW MCCAULEY
Address: 10418 BARRY BRIDGES SE
YELM WA 98597
Property Information:
Site Address: 10418 BARRY BRIDGES ST SE
Assessor Parcel No.: 62320002800 Subdivision
Contractor Information:
Name: SUNSET AIR INC
Address: TERRY MEDLOCK
5210 LACEY BLVD.
LACEY WA 98503
Contractor License No.: 10734
Project Information:
Project: MECHANICAL
Description of Work: ADD AIR CONITIONER
Permit No.: 20160183
Issue Date: 4/07/2016
(Work must be completed within 180 days)
Phone: 360- 400 -1548
Owner:
MILL POND
JODI MCCAULEY
Phone:
Expires: 12/31/2016
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
SUNSET AIR INC
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 confor with all applicable City of
Yelm regulations including those governing zoning and land subdivisio ,and addition, all covenants,
easements and restrictions o ecord. If applying as a co tor, I fu er ce ify that I am c rentl
registered in the State o shingt >
Signature °� ate 7
Firm
Lot: 28
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Citt of Yelm
(36 ) 458 -3244
REC #: 00227543 4/07/2016 2:33 PM
OPER: CO TERM: 001
REF #: 35279
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20160183 29.KCR
MCCAULEY, JODI /ANDFEW
10418 BARRY BRIDGES ST SE
MECH 29.50CR
TENDERED: 29.50 CHECK
APPLIED: 29,50-
CHANGE: 0.00
CITY OF YELM�
RESIDENTIAL BUILDING PERMIT APPLICATION FORM /� IV083
Project Address: i oca (j a 1'r�'/ �I ( d1 S1 Parcel #: Z e(, V
Subdivision: Lot #: Plan #: Zoning:
❑ New Construction ❑ Re -Model / Re -Roof / Addition ❑ Home Occupation Sign
❑ Plumbing Y QAechanical ❑ Mobile / Manufactured Home Placement El Other
Project Description /Scope of Work: Cur ma m %pl add 4.0?
Project Value:
Building Area (sq. ft) 1st Floor 2nd Floor 3`d Floor -
Covered Patio Covered Porch Patio
Garage -2 car 3 car.
Deck
# Bedrooms # Bathrooms_ Heating: GAS /OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
/f yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER
ADDRESS / J 'S EMAIL
CITY S E ZIP TELEPHONE
PLl1MWN6 CONTRACTOR TELEPHONE
ADDRESS '( EMAIL
CITY STATE ZI FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
=C CTOMECA TELEPHONE
ADDRESS 2 U S �� EMAIL i��YY1 P � J11�f f'f�Li �� LOV►�.
CITY Q S ATE_,Ja- ZIP Q:)Q -22 FAX �)16t2'45U— L1!JQQ
CONTRAC R'S LICENSE #� (Y1S111 t 212L_VK2�P DATE CITY LICENSE # l �J
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 ribed property will be in accordance with the laws, rules and regulations of the State of Washington and the
City of Yel
4)jv
Applicant's Si nature Date
Owner / Contractor / Owner's Agent / Contractor's Agent (Please circle one.)
All permits are non - transferable and will expire if work authorized ,ti n
within 180 days of issuance, or if work is suspended or abandonerf..M I V$
G 7 2! 15
105 Yelm Avenue West
Yelm, WA 98597
www.ci.yelm.wa.us
BY. -------------- - - - - --
(360) 458 -3835
(360) 458 -3144 FAX