20160254 Permit Pkg 06222016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: MARY LOUISE CLEMENS
Address: 15030 LONGMIRE ST SE
YELM WA 98597
Property Information:
Site Address: 1gnin I nlklirnniD0 er CC
Assessor Parcel No.: 21724420502 Subdivision:
Contractor Information:
Name: G & G HEATING
Address:
8140 OLD HWY 99 SE
OLYMPIA WA 98501
Contractor License No.: GGHEA"`16207
Permit No.: 20160254
Issue Date: 6/22/2016
(Work must be completed within 180 days)
Phone:
Owner: MARY LOUISE CLEMENS
Lot:
Phone: 360 - 943 -0964
Expires: 01/21/2017
Project Information:
Project: MECHANICAL
Description of Work: INSTALL A SINGLE ZONE DUCTLESS HEAT PUMP
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
G & G HEATING
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 alfthe hat the proposed structure is in conformity with all applicable City of
Yelm regulations inclu verning zoning and land subdivision, and in addition, all covenants,
easements and restr ti n. If applying as a contractor, I further certify that I am currently
registered in the S of n.
Signature Date` ` 4
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cite of Yelm
(36 1) 458 -3244
RECA': 00235365 6/22/2016 11:37 AM
OPER: CO TERM: 001
REFA+ : 25657
PAID BY:
TRAM: 30.0000 BUSINESS LICENSE
G & G HEATING 2016
BUSINESS LICENSES & 25.00CR
TRAN: 33.0000 BUILDING G 5(CMRITS
20160254
CLEMENS, MARY LOUIE
15030 LONGMIRE ST SE
MECH 29.50CR
TENDERED:
54.50 ('HECK
APPLIED:
54.50 -
CHANGE:
0.00
j*oov
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: /60 _Z 41 t74�3,♦4c S� Parcel #:
Subdivision: Lot #: Plan #: Zoning:
New Construction I Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing )('Mechanical Mobile / Manufactured Home Placement Other
Project Descripti n /Scope of Work:_ 1wsT,9 t C S i '1�L- a� OVCA /e "sS Ik,4
Project Value: �i 7 00,
Building Area (sq. ft) 1St Floor 1' � S 2nd Floor IDS Garage Deck
Basement Carport Patio �Circle # Bedrooms # Bathrooms_ Heating: GAS /OTHER r ELECT One)
Are there any environmentally sensitive areas located on the parcel?
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: 044 LOU C-` t-*/_5
ADDRESS 'A. 3"i S6 EMAIL
CITY 4& t-1 STATEtJ�ZIP $S TELEPHONE -3 O
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR ie — it 1;- TELEPHONE 3eO tel ` Q
ADDRESS ib$D 1q.24 EMAIL
CITY D % STATE ZIP Q FAX
CONTRACTOR'S
LICENSE # A-* * EXP DAT CITY LICENSE #
WV
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby certify that a ve information is correct and that the construction on, and the occupancy and the use of the
above described o ill be in accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
a9- /�
Applic is 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 days
105 Yelm Avenue West (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
www.ei.yelm.wa.us