20160306 Permit Pkg 08032016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: ROBERT & ROBIN LEE
Address: 10806 UMTANUM ST SE
YELM WA 98597
Property Information:
Site Address: 10806 UMTANUM ST SE
Assessor Parcel No.: 32640001800 Subdivision:
Contractor Information:
Name: B -LINE PLUMBING
Address:
12911 OLD HWY 99 SE
TENINO WA 98589
Contractor License No.: BLINEPL87ONB
Project Information:
Project: MECHANICAL
Description of Work:
REPLACE GAS LINE
Sq. Ft. per floor:
First
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Permit No.: 20160306
Issue Date: 8/0312016
(Work must be completed within 180 days)
Phone:
Owner: ROBERT LEE
Lot:
Phone:
Expires: 07/31 /2017
Heat Type (Electric, Gas, Other):
Contractor
B -LINE PLUMBING
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 State of Washington.
Signature c= %si'�" ' Date N-3 —/6
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cit�f of Mi
(36 1) 458 -3244
RECD`: 00239324 8/03/2016 8:47 AM
OPER: CO TERM: 001
REFS': 3021
PAID BY:
TRAM: 33.0000 BUILDING PERMITS
20160306 29.5(CR
LEE, ROBERT & ROBIh
10806 UMTANUM ST SE
MECH 29.5(CR
TENDERED: 29.50 (HECK
APPLIED: 29.50-
CHANGE: 0.00
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 1()20(? L)AI 0J0bCM Parcel #:
Subdivision: Lot #: Plan #: Zoning:
New Construction] I Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing / Mechanical Mobile / Manufactured Home Placement Other
Project Description /Scope of Work: ,�4,!, x,121
Project Value: 0_910_)
Building Area (sq. ft) Vt Floor 2nd Floor Garage Deck
Basement Carport Patio
# 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.
BUILDING OWNER NAME: : L *- e—
ADDRESS (n,?04� uAa A_# 4!J EMAIL
CITY `/eL STATE 6d4_. ZIP! �TELEPHONE
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # 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.
c
Applicant's ignature 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
105 Yelm Avenue West (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.yelm.wa.us