20160354 Permit Pkg 11012016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: SCOTT CRUMP
Address: P.O. BOX 2673
YELM WA 98597
Property Information:
Site Address: 14831 PRAIRIE VISTA LP SE
Assessor Parcel No.:
Contractor Information:
Name: SCOTT CRUMP
Address:
P.O. BOX 2673
YELM WA 98597
Contractor License No.:
Subdivision:
Permit No.: 20160354
Issue Date: 11/01/2016
(Work must be completed within 180 days)
Phone: 360- 458 -4411
Owner: SCOTT CRUMP
Lot:
Phone:
Expires: 0 /00 /0000
Project Information:
Project: MECHANICAL
Description of Work: GAS PIPE FOR GENERATOR. DUCT TEST REQUIRED
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
SCOTT CRUMP
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 Washingto .
Signature �� Date
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cite of Yolm
(361) 458 -3244
RECD': 00248340 11/01/2016 9 :30 AM
OPER: CO TERM: 001
REF #: 76362
PAID BY:
TRAM: 33.0000 BUILDING PERMITS
20160354 29,5(CR
CRUMP, SCOTT
14831 PRAIRIE VISTA LP SE
hIECH 29.5(CR
TENDERED: 29,50 [HECK
APPLIED: 29,50-
CHANGE: 0.00
AV369
CITY OF YELM
RESIDENTIAL BUILDING
Q PERMIT APPLICATION FORM
Project Address: 1 qg,3 i Pr6L;rrte ���in too c;6 Parcel #: -S I R tnC) n0 Lon, ?
Subdivision: Lot #: Plan #: Zoning:
New Construction Re -Model ( Re -Roof / Addition Home Occupation Sign
Plumbing X Mechanical -i Mobile / Manufactured Home Placement Other
Project Description /Scope of Work: Q �, ,pi fur'
Project Value:
Building Area (sq. ft) 1" Floor 2 "d Floor 3'd 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.
BUILDING OWNER NAME:
ADDRESS ` � ri t' - EMAIL
CITY STATE LOA ZIP e► 7 TELEPHON C-��'YSS_Q
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 GONTRACTOR&nCYtiCj Cie�triC. TELEPHONE &on ZC
ADDRESSa30C T EMAIL �L rm`�t-���Y`eYYli _ i� C4/V1
CITY _STATE_ ZIPja�FAX Z -
CONTRACTOR'S LICENSE #R6,uAuEC.4et6l9 EXP DATES 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.
ri 4
C1 1z 1� 1 0 i �t\` \\Q
Applicant's Si nature 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
within 180 days of issuance, or if work is suspended or abandoned
OCT J 12010
105 Yelin Avenue West
Yelm, WA 98597 (360) 458 - 3144 FAX
unv w, c i.ye lm. wa. us