20160256 Permit Pkg 06282016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458-3144
Applicant:
Name: PATRICK VAN CLEAVE
Address: 9239 BRENDAN DR SE
YELM WA 98597
Property Information:
Site Address: Q7'3Q RlPmunAN np SF
Assessor Parcel No.: 55360002300 Subdivision:
Contractor Information:
Name: SUNSET AIR INC
Address: 5210 LACEY BLVD.
LACEY WA 98503
Contractor License No.: SUNSEAI915131
Permit No.: 20160256
Issue Date: 6/28/2016
(Work must be completed within 180 days)
Phone:
Owner: PAT VAN CLEAVE
Phone:
Expires: 1/21/2017
Lot:
Project Information:
Project: MECHANICAL
Description of Work: REPLACE GAS FURNACE AND AIR CONDITIONER. DUCT 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 St at ' "of Washington.
Signature Date /
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cite of Mm
(361) 458 -3244
RECA': 00235595 6/28/2016 11:49 AM
OPER: CO TERM: 001
REFS': 35363
PAID BY:
TRAM: 33.0000 BUILDING PERMITS
20160227 29.50CR
WADLEIGH, STEVE / LEA -ANN
9307 PRAIRIE WIND
MECH 29.50CR
TRAM: 33.0000 BUILDING PERMITS
20160232 29.50CR
MASON, ANTHONY
14871 89TH AVE SE
MECH 29.50CR
TRAM: 33.0000 BUILDING PERMITS
20160257 29.50CR
HUDNELL, COLTEN & JENNIF
9870 JENSEN DR SE
MECH 29.50CR
TRAM: 33.0000 BUILDING PERMITS
20160256 29.50CR
VAN CLEAVE, PATRICV.
9239 BRENDAN DR SE
MECH 29.50CR
TENDERED: 118.00 CHECK
APPLIED: 118.00-
CHANGE: 0.00
CITY OF YELM
:�o'vsIS
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: q� � q V( ,ItlU alai 06_ Parcel #:
Subdivision:
Lot #: Plan #: Zoning:
❑ New Construction ❑ Re -Model / Re -Roof / Addition ❑ Home Occupation Sign
❑ Plumbing Mechanical r,, ❑n Mobile / Manufactured Home �Placement
,�J I-�❑ Other
Project Descriptio /nlScope of Work: CSI tq� �� Cur ��'��-tu' I O Y �. (, (Qr,
Project Value: Cp s JL C �.� A e c
Building Area (sq. ft) 13t Floor 2nd Floor 3d Floor_
Covered Patio Covered Porch Patio
Garage -2 car 3 car
Deck
# Bedrooms! # Bathrooms— Heating: GAS /OTHER or ELECTRIC (Circle One)
Are there any environmentaily sensitive areas located on the parcel?
If yes, a completed environmental checklist must accompany permit application.
VowC
ADDRESS t,I`l EMAIL
CITY P IVY? STATE I,JG1 ZIP TELEPHONE
LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
_ TELEPHONE
ADDRESS EMAIL
CITY S TE ZIP FAX
CONTRACTOR'S LICENSE EXP DATE CITY LICENSE #
�� _._
- ELEPHONE
ADDRESS TEMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE —CITY LICENSE #
=..RN L)A5r JnI tidfJt.i TELEPHONE 71PU "i�12 "`'I''I�(�
ADDRESS U 5 _ EMAIL 4�ivY1 t�_ ,q,111,5
CITY S ATE�ZIP Q,j�03 FAX
CONTRAC R'S LICENSE #SJ c "" aJaL0QXP DATE _CITY LICENSE #
"514-1
(i"i
Copy of mitigation agreement with Yelm Community Schools, if applicable.
hereby certify that the above Information Is correct and that the construction on, and the occupancy and the use of the
above deWlixd property will be in accordance with the laws, rules and regulations of the State of Washington and the
City of X61 m.
Applicants Signature Date
Owner / Contractor / Owner's Agent 1 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 da s
o�c m
105 Yelm Avenue West (360) 4 5
Yelm, WA 38597 (360) 4 -3 JTVXT`� '—' - - -
wwwA.yelm, w a. us