20160216 Permit Pkg 05122016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: DANNY & RACHEL CRABTREE
Address: 10008 TYLEAH CT SE
YELM WA 98597
Property Information:
Site Address: 1nnnR TYI FAH f'_T SF
Assessor Parcel No.: 47130000100
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 HEAT PUMP
Sq. Ft. per floor:
First
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Permit No.: 201 60216
Issue Date: 5/1212016
(Work must be completed within 180 days)
Phone: 253 - 213 -1845
Owner: DANNY CRABTREE
Subdivision: FAIRWAY ESTATES Lot: 1
Phone: 705 -8590
Expires:
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 the State of Washington. y
Signature Date SCI �I
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City M451ell44
(360
REC #: 00231357 5/12/2016 1 :42 PM
OPER: CO TERM: 001
REF #: 17212
PAID BY:
TRAN: 33.0000 BUILDING
29 P[RMITS
20160216
CRABTREE, DANNY & RACHEL
10008 TYLEAH CT SE
MECH
TENDERED: 29.50 (HECK
APPLIED: 29.50 -
CHANGE: -----o —00
From:Black Hills Inc
360 705 8584 05112/2016 08:42 #568 P.002/003
CITY OF YELM Zbl (pb vI
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: y ,� °;10 1 iii ?i `� Parcel #: ! 0 0
Subdivision: Lot #: Plan #: Zoning:
C New Construction Re -Model / Re -Roof / Addition ❑ Home Occupation Sign
u Plumbing echanical ( Mobile / Manufactured Home Placement Other
Project Description /Scope of Work:1..�� U i "S o.� p't.1` v�-'"
Project Value: 4
Building Area (sq. ft) 1St Floor 2"d Floor 3`d Floor Garage -2 car 3 car
Covered Patio Covered Porch Patio
# Bedrooms_ # Bathrooms_ Heating OTHER o ELECTRI ' (Circle One)
Are there any environmentally sensitive areas located on the parcel?
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME-.1 A ' 1V ' A,- V"
ADDRESS'` 1) ^A.-- EMAIL.
CITY' s ,STATE!, ZIP q J =r - TELEPHONE C G� h l 3 ,- t
`ti C �
ARGATECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL.. ONTRACT0:1R TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
PLUM NO CONTRACTOR TELEPHONE
.....................
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR f TELEPHONE CoLec
ADDRESS." ` 'o, EMAIL OI a
CITY STATEIAJ�- _ZIP q N_d FAX
CONTRAC' OR'S LICENSE #LWki <H 4 €VC4'_K_ EXP DATE2LI �C1TY LICENSE # t( % —/f a
r
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 be in accordance with the laws, rules and regulations of the State of Washington and the
Citylof Yelm. l
s p
(fit's Signath kJ hate
! Contractpr /Owner's Agent / ContkaIl;tor's Agent (Please circle one,)
All permits are noW 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.ci.yelm.wa.us
MCIE9IFT
8Y- _a-s---- .,-- - ---- —
(360) 458 -3835
(360) 458 -3144 FAX