20160202 Permit Pkg 04222016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Permit No.: 201 60202
Issue Date: 4/22/2016
(Work must be completed within 180 days)
Applicant:
Name MIKE UNDERWOOD Phone: 360- 458 -8445
Address: 10330 THIRD ST SE
YELM WA 98597
Property Information:
Site Address: 10330 THIRD ST SE Owner: MIKE UNDERWOOD
Assessor Parcel No.: Subdivision:
Contractor Information:
Name: B -LINE PLUMBING Phone:
Address:
12911 OLD HWY 99 SE
TENINO WA 98589
Contractor License No.: BLINEPL87ONB Expires: 7/31/2016
Project Information:
Project: MECHANICAL
Description of Work: REPLACE WATER HEATER
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
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 contr ctor, I further certify that I am currently
registered in the S to of Washington.
i�Signature Date Z Z
Firm
Lot:
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Ye]M
(36 ) 45B -3244
REC #: 00229336 4/22/2016 11:32 AM
OPER: CO TERM: 001
REF'# : 5489
PAID BY: B -LINE PLUMBING
TRAN: 33.0000 BUILDING PERMITS
20160202 29.50CR
UNDERWOOD, MIKE
10330 THIRD ST SE
MECH & 50CR
TENDERED: 29,50 CHECK
APPLIED: 29.50-
CHANGE: 0,00
i
I
CITY OF YELM
2 z°-z-
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: IOC -3rA 5t ;. & Parcel #: to] 20 000Q C-)
Subdivision: Lot #: Plan #: Zoning:
New Construction i Re -M
Plumbing 'Mechanical nn
Project Description /Scope of Work: K
Project Value:,�—T Doc
Building Area (sq. ft) 1s' Floor
Basement
# Bedrooms_ # Bathrooms.
odel / Re -Roof / Addition 1 I Home Occupation Sign
n Mobile / Manufactured Home Placement ! Other
2nd Floor Garage Deck
Carport Patio
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: W O
ADDRESS 0 EMAIL
CITY c TELEPHONE tyL O
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 - TELEPHONE `
ADD s L ►I (31cJt EMAIL
CITY STATE ZI FAX O &L
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE # (p
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.
Le ylzzl J l,Q
Date
Applicant's Signature D— e r
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
www.ci.yelm.wa.us