20160184 Permit Pkg 04072016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Permit No.: 20160184
Issue Date: 410712016
(Work must be completed within 180 days)
Applicant:
N ANTHONY & STAC BLANCO Phone: 360- 400 -0736
ame.
Address: 15320 104TH WAY SE
YELM WA 98597
Property Information:
Site Address: 15320 104TH WAY SE Owner:
Assessor Parcel No.: 62320003700 Subdivision: MILL POND
Contractor Information:
Name: FAST WATER HEATER Phone:
Address:
12601 132 ND AVE. SE
KIRKLAND WA 98034
Contractor License No.: 10236 Expires: 12/31/2016
Project Information:
Project: MECHANICAL
Description of Work: REMOVE AND REPLACE GAS WATER HEATER
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
ANTHONY BLANCO
Fees:
Item
MECHANICAL
Contractor
FAST WATER HEATER
TOTAL FEES:
Applicant's Affidavit:
certify th I have read and examined the information contained within the application and know the same
to be true a correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm reg lations incl those governing zoning and land subdivision, and in addition, all covenants,
Basemen s and s ctio of record. If applying as a contractor, I further certify that I am currently
registere in th ate of ashington. y
Signature ` e Date '
Firm
Lot: 37
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
city of Yelm
(36 ) 456 -3244
REC #: 00227634 4/07/2016 4:49 PM
OPER: CO TERM: 001
REF #: 20771
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20160184 29.50CR
BLANCO, ANTHONY & clTAC
15320 104TH WAY SE
MECH 29.50CR
TENDERED:
29.50 CHECK
APPLIED:
29.50 —
CHANGE:
0.00
zoaeo 104
CITY OF YELM
15l/ 9 3 0
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: V52 I ULI I,�`� �03
W"Parcel '
Subdivision: Lot #: Plan #: — Zoning: 12
New Construction Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing `Mechanical i Mobile / Manufactured Home Placement ' ^Ot'her �,� D r ,, , -
Project Descriptio Scope of Work: ?,e �; \ C / 1-e ill 0 C� � l ✓ Ud a� " i64e r
Project Value:
1
Building Area (sq. ft) 1" Floor 2nd Floor 3rd Floor Garage -2 car 3 car.
Covered Patio Covered Porch Patio Deck
# Bedrooms # Bathrooms_ Heatin : GAS/ THER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
If yes, a completed environmental checklist must accompany permit application.
ADDRESS
! CITY - --
ADDRESS
CITY
�010
AIL_
STATE ZIP TELEP
EMAIL
STATE ZIP
'S LICENSE # EXP DATE -I SSE #
PLUMBING TELEPHONE
ADDRESS
CITY STATE ZIP FAX
C CTOR'S LICENSE # EXP DATE CITY LICENSE # —
ANtCA f ACTOR 0- TELEPHONE
ADDRESS I t11 4 S C EMAIL _ K E H-t- E LC%) 5k 10 kp,�_ -
CITY 15 /t P l I STATE ZIP cKb I I FAX
CONTRACTOR'S LICENSE #fASNJW+fC1L/3B C EXP DATE__�(- CITY LICENSE # - to
I - Lq - S
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.
LUL,�A al�A
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 day;01
C���'v�M �11-
4 J.%0.
105 Yelm Avenue West (360) 458 -3835
Yelm, WA 98597 By . ............. (360) 458 -3144 FAX
www.ci.yelm.wa.us