20160321 Permit Pkg 09072016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: CHEHALIS SHEET METAL
Address: 350 SW RIVERSIDE DR
CHEHALIS WA 98532
Property Information:
Site Address: lAnr.7 Rf`D0V vAi i =v on e�
Assessor Parcel No.:
Contractor Information:
Name: CHEHALIS SHEETMETAL
Address:
350 SW RIVERSIDE DR
CHEHALIS WA 98532
Contractor License No.: CHEHASM252
Subdivision:
Permit No.: 20160321
Issue Date: 9/07/2016
(Work must be completed within 180 days)
Phone:
Owner: TIM GIBBONS
Phone:
Expires: 12/31/2011
Project Information:
Project: MECHANICAL
Description of Work: INSTALL DUCTLESS HEAT PUMP
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
CHEHALIS SHEETMETAL
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 inPe-S 1/V83hirgton.
Signature Date
Firm
Lot:
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
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9/08/2016 11:39 AM
RECD' :
OPEF; : CO TERM.
001
REFS': 3515
PAID BY:
TRAM: 33.0000
BUILDING 5(CR 1�
20160HEHALIS SHEET META[
VALLEY E'
14057 BERRY
5( R
MECH
TENDERED:
29.00 (HECK.
0.50 CASH
F,PPLIED :
29.50-
CHANGE:
0.00
KAREN BENNETT; PERMIT COORDINATOR 360.458.3835
// �� CITY OF YELM
S RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 'h #d" BERRY VALLEY RD SE Parcel #:
Subdivision:
Lot #: Plan #: Zoning:
0 New Construction _ Re -Model / Re -Roof / Addition - Home Occupation Sign
D Plumbing X Mechanical _ Mobile / Manufactured Home Placement - Other
Project DescriptiOn /Scope of Work: INSTALL RETRO DUCTLESS HEAT PUMP
Project Value: $6886.20
Building Area (sq. ft) 15t Floor 2 "d Floor 3" 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.
Y / /
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
LICENSE #
ADDRESS EMAIL
CITY STATE _ZIP TELEPHON
i� TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTORS LICENSE # EXP DATE CITY LICENSE #
�T CHEHALIS SHEET METAL TELEPHONE 60.352.1996
ADDRESS 350 SW RIVERSIDE DR EMAIL CHEHALISSHEETMETALOLY @COMCAST.NET
ClTyCHEHALIS STATE`"A ZIP 98532 FAX 360.292.7456
CONTRACTORS LICENSE #CHEHASM252MH EXP DATE�_,,CITY LICENSE #
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 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! 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
l'V�— s z
1 05 Yelm Avenue West
u =ac'u�.ci_yetrn.u�a.us
(360) 453 -3835