20160299 Permit Pkg 07202016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: GUY GRAYSON
Address: 507 VAN TRUMP AVE NW
YELM WA 98597
Property Information:
Site Address: 4117 \ /AAI TO11 tnn0 QT KnAi
Assessor Parcel No.:
Contractor Information:
Name: GUY GRAYSON
Address:
507 VAN TRUMP AVE NW
YELM WA 98597
Contractor License No.:
Project Information:
Project: MECHANICAL
Description of Work: REPLACE FURNACE
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Subdivision:
Permit No.: 20160299
Issue Date: 7120/2016
(Work must be completed within 180 days)
Phone:
Owner: GUY GRAYSON
Phone:
Expires: 0 /00 /0000
Heat Type (Electric, Gas, Other):
Contractor
GUY GRAYSON
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 St f Washin n. /
Signature '�� Date )'- Z O
:Firm `r 14c,
Lot:
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cite of Yolm
(361) 458 -3244
REC #: 00238282 712012016 9 :50 AM
OPER: CO TERM: 001
REF #: 39414
PAID BY:
TRAM: 33.0000 BUILDING PERMITS
20160299 29.5(CR
GRAYSON, GUY
507 VAN TRUMP ST NW
MECH 29.5(CR
TRAM: 30.0000 BUSINESS LICENSE
AIR HANDLERS INC
BUSINESS LICENSES & 35.000R
1ENDERED: 64.50 (HECK
APPLIED: 64.50-
CHANGE: -
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: S-o I V Ga'I f.4 Avy N L) Parcel #:
Subdivision:
Lot #: Plan #: Zoning:
New Construction r', Re-N/
Plumbing - Mechanical
Project Description /Scope of Work:_
Project Value:
Building Area (sq. ft) 1" Floor
Basement_
# Bedrooms # Bathrooms
'�_ ° 1 ce D a-i'r
odel / Re -Roof / Addition Home Occupation Sign
Mobile / Manufactured Home Placement Other
C Z'1� �G t-C.. �•rrJ �.C.Q_
2 I Floor Garage Deck
Carport Patio
Heating: GAS /OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? /V
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME:
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
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 #
MECHANICAL CONTPkCTOR 4. AA-TELEPHONE 3ba i i y V 2�
ADDRESS t EMAIL
CITY STAT ZIP_ (1T5i o i FAX
CONTRACTOR'S LICENSE #� -1 XP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable.
1 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.
Applicant's Signature Date
Owner / Contractor / ner'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
105 Yelm Avenue West (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.yelm.wa.us