20160218 Permit Pkg 05162016gg 0 p3
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: JADEJOHNSTON
Address: 14413 98TH WAY SE
YELM WA 98597
Property Information:
Site Address: 14413 98TH WAY SE
Assessor Parcel No.: 78640119800
Contractor Information:
Name: BLACK HILLS, INC
Address:
1003 85TH AVE SE
OLYMPIA WA 98501
Contractor License No.:
Project Information:
Project: MECHANICAL
Description of Work: INSTALL AC UNIT
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Subdivision
Permit No.: 201 60218
Issue Date: 5/16/2016
(Work must be completed within 180 days)
Phone: 360- 596 -3756
Owner:
TAHOMA TERRA
JADEJOHNSTON
Phone: 705 -8590
Expires: 0 /00 /0000
Heat Type (Electric, Gas, Other):
Contractor
BLACK HILLS. 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 th# §tate of shin,ton. / I
Signature V Date b
Firm 16-P A
Lot: 198
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Yelm
(36 ) 458 -3244
REC #: 00231887 5/16/2016 10:53 AM
OPER: CO TERM: 001
REF #: 17224
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20160218 29.5GCR
JOHNSTON, JADE
14413 98TH WAY SE
MECH 29.56CR
TENDERED: 29.50 (HECK
APPLIED: 29.50-
CHANGE: __ 0
From:Black Hills Inc
360 705 8584 05/16/2016 07:06 #586 P.002/003
CITY OF YELM
)X1UOZG&
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address�A �'�`� iAa,i�vi � C Parcel #:`� �� �i't 1 q ry �`�
3
Subdivision: Lot #-. Plan #: Zoning:
E New Construction C-J Re -Model / Re -Roof I Addition G Home Occupation Sign
is Plumbing V- Pechanical Mobile / Manufactured Home Placement [:': Other
-. 0 Al, L
Project Description/Scope of Work: ! �.��� i� ti'
Project Value: 0(p l
Building Area (sq. ft) 1s` Floor 2 "d Floor 3`d Floor Garage -2 car 3 car
Covered Patio Covered Porch Patio Deck
#. Bedrooms_ # Bathrooms_ Heating: GAS /OTHER or �CTRIC Circle One)
Are there any environmentally sensitive areas located on the parcel?
!f yes, a completed environmental checklist must accompany permit application.
BUILDING OWN R Y.
ADDRESS 1 . ' ' i EMAIL
CITY U. V_ STATE € ZIP 1 -l. TELEPHONE c ; i 17� -_}
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 #
MECHANICALCONTRACTOR. I ��e.r' 1JtS.11'?f TELEPHONE ;Q.0' -
ADDRESSj1663 M1ft EMAIL
CITY -A STATE ZIP cs � FAX
CONTRACTOR'S LICENSE #1%7 t ! ( --EXP DATE�CITY LICENSE # (ttc °E (i }
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I h reby certify that the above information is correct and that the construction on, and the occupancy and the use of the
ak ve described property will be in accordance wit4 a ws, rules and regulations of the State of Washington and the
C'h
f
Applicant's Signafiure I Date
Owner I Contractor 1 War's Agent I Cd'n ctor'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 dF, (360) 458 -3835
Yeim WA 98597 (360) 458 -3144 FA.X
www.ei.yelm.wa.us
9K��� oa
Karen Bennett
From: Ashley Saunders [ashley @blackhillsinc.com]
Sent: Monday, May 16, 2016 10:01 AM
To: Karen Bennett
Subject: Site Plan
Attachments: fisher site plan.pdf
Here is the site plan you asked for.
Let me know if you need anything else.
Thank you,
Ashley Saunders
Black Hills Inc.
1003 85th Ave SE
Olympia, WA 98501
360- 972 -7912