20160200 Permit Pkg 04272016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: ROBIN PELEKAI
Address: 16121 VANCIL LP SE
YELM WA 98597
Property Information:
Site Address: 18121 VANCIL LP SE
Assessor Parcel No.: 69270001200
Contractor Information:
Name: SUNSET AIR INC
Address: TERRY MEDLOCK
5210 LACEY BLVD.
LACEY WA 98503
Contractor License No.: SUNSEA1915131
Permit No.: 20160200
Issue Date: 4/27/2016
(Work must be completed within 180 days)
Phone: 360- 458 -2071
Owner: ROBIN PELEKAI
Subdivision: Lot:
Phone:
Expires: 1/21/2017
Project Information:
Project: MECHANICAL
Description of Work: DUCT LEAKAGE TEST REQUIRED
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 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 at of Washington. 7
signature Date
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City f Mi
(36 ) 458-3244
REC#: 00229562 412712016
OPER: CO TERM.- 001 8:14"AM
REF#: 35302
PAID BY:
IRAN: 33.0000 BUILDING PERMITS
20160200 29,50CR
PELEKAI, ROBIN
MECH 16121 VANCIL LP SE
29,50CR
TENDERED: 29,50 CHECK
APPLIED: 29.50 -
CHANGE:
0.00
i
t
CITY OF YELM a W V
++
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 4 D 1 7-1 06106 6 i�-1✓bt�— Parcel* (� "4� I �`� t%DO �PV
Subdivision: Lot #: _ Plan #: Zoning:
n New Construction Ci Re -Model / Re -Roof / Addition ❑ Home Occupation Sign
O Plumbing 'Mechanical f cl as ( Manufactured Home Placement [I Other
Project Description /Scope of Work: . 1 aJ q (r,�
"Iu
�' l Our-"'
i
Project Valuer
Building Area (sq. ft) Vt Floor 2nd Floor 3rd Floor Garage -2 car 3 car_
Covered Patio Covered Porch Patio Deck
# Bedrooms # Bathrooms_ Heating: GAS /OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parce(?
If yes, a completed environmental checklist must accompany permit application.
tI— LICENSE #
ADDRESS EMAIL
CITY STATE N ZIP_ TELEPHONE
TELEPHONE
ADDRESS EMAIL
CITY TATS ZIP FAX
CONTRACTOR'S LICENS EXP DATE CITY LICENSE #
TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LI NSE# EXP DATE CITY LICENSE#
(�if)(,`rELEPHONE V ' J(W- �IJ
ADDRESS EMAIL AIYI �I Gl AC G
CITY _S TE ZIP FAX
CONTRACT 'S LICENSE #li -�+1 -� P DATE CITY LICENSE # '
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby ertify that the above information is correct and that the construction on, and the occupancy and the use of the
above de cribed property will be in accordance with the laws, rules and regulations of the State of Washington and the
City of Y Im.
Ap cant's Signa Date
Owner 1 Contractor / Owner's Agent / Contractor's Agent (Please circle one.)
All permits are non - transferable and will expire if work authorized by such n
within 180 days of issuance, or if work is suspended or abandoned for a pe
tP� ti 2616
105 Yelm Avenue West
Yel7n, WA 98597
www.ci.yelrn.wa.res
(360) 458 -3835
(360) 458 -3144 FAX