20160292 Permit Pkg 07152016C. THE
City of Yelm
Community Development Department
AL
es
Building Division
Phone: (360) 458 -8407
YELM
Fax: (360) 458 -3144
Applicant:
Name: MARIA & JOSE URENA
Address: 15592 CHAD DR SE
YELM WA 98597
Property Information:
Site Address: 1 9;J;Q7 f _HAIL r)p SF
Permit No.: 201 60292
Issue Date: 7/1512016
(Work must be completed within 180 days)
Phone: 253 - 948 -5464
Owner: JOSE AND MARIA URENA
Assessor Parcel No.: 41610004200 Subdivision: CHERRY MEADOWS Lot: 42
Contractor Information:
Name: SUNSET AIR INC
Address: TERRY MEDLOCK
5210 LACEY BLVD.
LACEY WA 98503
Contractor License No.: SUNSEAI91581
Expires:
Phone:
1/21/2017
Project Information:
Project: MECHANICAL
Description of Work: AIR CONDITIONING INSTALLATION
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
SUNSET AIR 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 includ #g�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 Date
Firm 5105' hl r
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date.
By:
( l�O' Be3m44
(36
RECD': 00237581 7/15/2016 12:02 PM
Opp: Co TERM. 001
REEF: 35377
PAID BY:
TRAM: 33.0000 BUILDING 5 CRITS
20160292
URENA, MARIA & JOSE
15592 CHAD DR S29 5(CR
MECH
1ENDERED: 29.50 (HECK
APPLIED: 29.50 -
CHANGE: 0.00
Project Address
Subdivision:
CITY OF YELM
l��
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
t 15 2 Ch ac - b ( 5 E- Parcel #: 'f 1U 10QCktd�Q-Q
Lot #: Plan #: Zoning:
❑ New Construction ❑ Re -Model / Re -Roof / Addition D Home Occupation Sign
❑ Plumbing "echanical (} El Mobile / Manufactured Home Placement ❑ Other
CuProject Description /Scope of Work: r Cub 6W ack�,
Project Value: 1111)V
Building Area (sq. ft) 1St Floor 2nd Floor 3rd 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.
MEOW.
EMAIL
TELEPHONE
�� - -- — LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
,w TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP. FAX —
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
�.._::; �.��,.� l �,Csi" J111 t:,,t,I! t� TELEPHONE ��1P0 ""`ISIQ'`'��
ADDRESS�)DL.e�f I3 t)f 5(,_ EMAIL Y �Y'(1 ��Jf1,S!! 1�(t��, Lb►oL�
CITY SATE It�ILr ZIPC3�_FAX —
CONTRACT R'S LICENSE #`,� 1Fi�i Q�OLf/XP DATE CITY LICENSE #�
Copy of mitigation agreement with Yelm CommutnifyIchools, 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 in accordance with the laws, rules and regulations of the State of Washington and the
City ofd' lin.
Appli ant's Si nature Date
Owner IIContractor I Owner's Agent I 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
Yelm, WA 98597
www.cl.yelm.u�a. us
MCMETT6
8 Y:
(360) 458 -3144 FAX