20160233 Permit Pkg 05272016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458-3144
Applicant:
Name: MIKE EASTERLY
Address: 14401 98TH WAYSE
YELM WA 98597
Property Information:
Site Address: 1AAni gRTH WAY SE
Assessor Parcel No.:
Contractor Information:
Name: BLACK HILLS, INC
Address:
1003 85TH AVE SE
OLYMPIA WA 98501
Contractor License No.: 10091
Permit No.: 20160233
Issue Date: 5/27/2016
(Work must be completed within 180 days)
Phone:
Owner: MIKE EASTERLY
Subdivision: TAHOMA TERRA
Phone:
Expires: 12/31/2016
Project Information:
Project: MECHANICAL
Description of Work: INSTALL HEAT PUMP EAST SIDE OF THE RESIDENCE
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
MIKE EASTERLY
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 State „of Washington.
Signature - (,' G`�� ” Date
Firm
Lot: 200
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Citt of Mm
(36 } 456 -3244
REC #: 00232645 5/27/2016 3:26 PM
OPER: CO TERM: 001
REF #: 17276
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20160233 29.50CR
EASTERLY, MIKE
14401 96TH WAY SE
MECH 29.50CR
TENDERED: 29.50 CHECK
APPLIED: 29.50 -
CHANGE: 0.00
From :Black Hills I11C
360 705 8584 05127/2016 08:27 #684 P.002/003
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: " tea = Parcel #:
Subdivision: Lot #: Plan #: Zoning:
New Construction i "1 Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing V9 Mechanical - Mobile / Manufactured Home Placement Other
Project Description /Scope of Work:'
Project Value: �
Building Area (sq. ft) 1St Floor 2nd Floor 3`d 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 parcel?
If yes, a completed environmental checklist must accompany permit application.
BUILDINGiOWNERNAME:l t�CAievmLA
ADDRESS A f EMAIL
CITY t STATE ZIP �TELEPHONE - d
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 CONI'RACTR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
ADDRESS r 2 fta % EMAIL
CITY �`l i STATE i Vft— ZIP 11 FAX
CONTRALTO 'S LICENSE # r7 a— j) s ai L P DATE r'FCITY LICENSE #
K H 10 U alp} L._
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 i accordance with the laws, rules and regulations of the State of Washington and the
City of YPIm. �,� n .
Applicant's Signaturle
Owner ( Contractor � w1 ner's Agent / Con
1('9
Date
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
Yelm, WA 98597,
www.c i.vel m.Iv a. us
(360) 458 -3835
(360) 458 -3144 FAX
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