20160316 Permit Pkg 08302016 VOIDEDCity of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: TIMOTHY & CARRI GIBBONS
Address: 14507 BERRY VALLEY RD SE
YELM WA 98597
Property Information:
Site Address: 14507 BERRY VALLEY RD SE
Permit No.: 20160316
Fee Calculation Worksheet
Phone:
Owner: TIM AND CARRI
GIBBONS
Assessor Parcel No.:
21724230700 Subdivision:
Project Information:
Project: MECHANICAL
Description of Work:
INSTALL RETRO DUCTLESS HEAT PUMP
Sq. Ft. per floor:
First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Units
MECHANICAL PERMIT 1
WHOLE HOUSE FAN /MISCELLANEOUS 1
TOTAL FEES:
PAYMENTS MADE:
BALANCE DUE:
Lot:
Fees
$ 20.00
$ 9.50
$ 29.50
$ 0.00
$ 29.50
AUG /30/2016/TUE 09:59 AM FAX No, P,003/004
KAREN BENNETT; PERMIT COORDINATOR 360.456.3835
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
14W%7 BERRY VALLEY RD SE
Project Adores Parcel :
Subdivision: Lot # Plan #: Zoning;
D New Construction - Re -Model / Re -Roof / Addition D Home Occupation Sign
L] Plumbing 6 Mechanical r Mobile / Manufactured Home Placer -tent _7 Other
Project Description /Scope of Work INSTALL RETRO DUCTLESS HEAT PUMP
Project Value: $6886.20
Building Area (sq. ft) l at Floor 2 "d 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?
rf yes, a completed environmental checklist must accompany permit application,
ADDRESS _ � EMAIL
CITY STATE ZIP TELEPHOI�iE
LICENSi= #
ADDRESS ___ EMAIL
CITY STATE J ZIP TELEPHONE
TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTORS LICENSE # EXP DATE CITY LICENSE #
TELEPHDNE
ADDRESS EMAIL
CITY STATE FAX __
CONTRACTOR'S LICENSE # EXP LATE CITY LICENSE M
i CHEHALIS SHEET METAL TELEPHONE 60.352.1996
ADDRESS360 SW RIVERSIDE DR EMAIL - HP-HALISSHEr7METALOLY @COMCAST.NE7�
GlTyCHENALIS cS'IAT•EWA ZIP 16151 FAX 360.292.7456
CONTRACTOR'S LICENSE #cHEHASM252MH - EXP DATE,,, C Y LICENSE # -
Copy of mitigation agreement with Yelm Community Schools, If applicable,
I her9q certify that the above Information 9s correct and that the construction ort, and the, occupancy and the use or the
ab a eecr1had property will be In acrorrlatrce with the laws, rules and regulations of the State of Washington and the
Clay of elm. - - / Zb
App ant's Signa Date
Owner / Contractor ! Owner's Agent / Contractor's Agerd (Please circle one.)
All permits are non-transferrable and will expire if work authorized by such permit is not begun
within 1930 days of issuance, or if work Is suspended or abandoned for a period o TIMICD
F41016�
3 � 20i6
10 5 YOrn Avenue West (360)
AUG /30/2016/TUE 09:59 AM FAX No,
FAX
TO: KAREN BENNETT FROM:
FAX: 360.458.3144
RE: MECHANICAL PERMIT
PATTY AT CSM
FAX: 360.352.1996
# OF PGS, 4
INCLUDING
COVER
SUBJECT DATE: 8130116
NOTES
ONE OF THE TECHS WILL BE IN WITH A CHECK FOR $29.50 ON OR BEFORE 9/7
TO PICK UP THE PERMIT. THANK YOU SO MUCH FOR YOU HELP THIS MORNING!
P. 001/004