20160215 Permit Pkg 05122016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Permit No.: 20160215
Issue Date: 5112/2016
(Work must be completed within 180 days)
Applicant:
Name DANIEL & JOANNE DAVIS Phone: 541 - 499 -3317
Address: 15701 92ND WAY SE
YELM WA 98597
Property Information:
Site Address: 15701 92ND WAY SE Owner: DANIEL DAVIS
Assessor Parcel No.: 55360000500 Subdivision:
Contractor Information:
Name: FAST WATER HEATER Phone: 425 - 636 -7084
Address:
Lot:
11715 N CREEK PKWY S #C -106
BOTHELL WA 98011
Contractor License No.: 1610236 Expires: 12/31/2016
Project Information:
Project: MECHANICAL
Description of Work: REMOVE AND REPLACE GAS WATER HEATER
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
FAST WATER HEATER
TOTAL FEES:
Applicant Affidavit:
I cert ify th t I have read and examined the information contained within the application and know the same
to be true nd correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regu ations includin those governing zoning and land subdivision, and in addition, all covenants,
easement and r1sWai ons record. If applying as a contractor, I further certify that I am currently
registered i the tate of W shington. �,�+
Signature J.A , (— -� cJ f _ Date p
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Yelm
(36 ) 458 -3244
REC #: 00231323 5/12/2016 9:51 AM
OPER: CO TERM: 001
REF #: 20918
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20160215 29.50CR
DAVIS, DANIEL & JOANNE
15701 92ND WAY SE
MECH 29.50CR
TENDERED: 29.50 CHECK
APPLIED: 29.50-
CHANGE: 0.00
WW 1?10
CITY OF YELM 5q`�u "7-
RESIDENTIAL BUILDING PERMIT APPLICATION FORM %�j�
Project Address: 15� j QZ N D �� SE Parcel #: 55 3W oR "v 500
Subdivision:
Lot #: Plan #:
Zoning:
MW
New Construction Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing mechanical Mobile / Manufactured Home Placement Other
j��� f
Project Description /Scope of Work:?, p \%P /red ( u_ � S (/ia4 [1 6(Alk-
Project Value: 0
Building Area (sq. ft) 1St Floor 2nd Floor 3rd Floor Garage -2 car 3 car
Covered Patio Covered Porch Patio Deck
# Bedrooms # Bathrooms Heatin OGAS/ THEIR or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? �Ii 0
If yes, a completed environmental checklist must accompany permit application.
6 k _G NER NAME: Q?Cf T_ A_V (
ADDRESS I W-0 I l; EMAIL
CITY `I� STATE WA- ZIP q35,q TELEPHONE CJ71
E#
ADDRESS AIL
CITY STATE ZIP TELEPH
ADDRESS EMAIL
CITY TE ZIP
C R'S LICENSE # EXP DATE NSE #
PLUMBING C TELEPHONE
ADDRESS EMA
CITY STATE ZIP FAX
C CTOR'S LICENSE # EXP DATE_ CITY LICENSE #
MECHANICAL CONTRACTOR \J �E>Kl TELEPHONE S r
ADDRESS I t1l PlLJA)4 C EMAIL r-KE F ` f to f ,_
CITY b /1 P (I STATE ZIP 9ft 11 FAX
CONTRACTOR'S LICENSE #61STh W-i+ L/33 C EXP DATE_�/- CITY LICENSE # , 10
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 described property will be in accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
15'�5'Qe
Applicant's 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
j�gC�gIIC�7gj�
105 Yelm Avenue West p (360) 458 -3835
Yelm, WA 98597 B Y:........... (360) 458 -3144 FAX
www.ci.yelm.wa.us