20160345 Permit Pkg 10182016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: ZACHARY MENDEL
Address: 9838 GREENLEAF LP SE
YELM WA 98597
Property Information:
Site Address: 9838 GREENLEAF LP SE
Assessor Parcel No.: 84070005700 Subdivision
Contractor Information:
Name: BLACK HILLS, INC
Address:
1003 85TH AVE SE
OLYMPIA WA 98501
Contractor License No.: BLACKH1066JL
Project Information:
Project: MECHANICAL
Description of Work:
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Permit No.: 20160345
Issue Date: 10/1812016
(Work must be completed within 180 days)
Phone: 360- 870 -2015
Owner: ZACHARY MENDEL
WILLOW GLEN PHASE II
Lot: 57
Phone: 360- 239 -3776
Expires: 3/31/2017
Heat Type (Electric, Gas, Other):
Contractor
BLACK HILLS, INC
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 c ntractor, I further certify that I am currently
registered in t tate of Washington.
Signature // dG, / Date
Firm //. , �/ LZ I Ar
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City► of Mi
(361) 458 -3244
RECV 00247320 10/18/2016 9:23 AM
OPER: CO TERM: 001
REEF: 17681
PAID BY:
TRAM: 33.0000 BUILDING PERMII3
20160345 29 S CR
MENDEL, ZACHARY
9838 GREENLEAF LP SE
MECH 29 S CR
TENDERED: 29.50 (HECK
APPLIED: 29.50-
CHANGE: 0.00
From:Black Hills Inc 360 705 8584 10/18/2016 06:43 ^^ #542 P.002/003
C�LO 345
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICAT ION FORM
Project Address:�`� t ��Y2 Y� tC �! Parcel #:}�
Subdivision: Lot #: Plan #: Zoning:
L New Construction -1 Re -Model / Re -Roof / Addition - Home Occupation Sign
E Plumbing XMechanical Mobile / Manufactured Home Placement Other
Project Description /Scope of Work: I . 't _k V1 I )!
Project Value:
Building Area (sq. ft) 15i 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 OWN R AME:
ADDRESS U't , ' EMAIL
CITY O WIT I STATE VVM ZIP t{3 701�TELEPHONE C4--Ir? ° Ci (; -
ARCH ITECTIENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
NLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR GVy: RWj 1111' TELEPHNE ,U '
:
ADDRESS , S OEMAIL
CITY ()J\AW 2a, STATE SPC- ZIP FAX
CONTRAC'TOR'S LICENSE 96€ Fkl 0t,�Ik)L, EXP DATE`!I` !TY 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
abo4 described property in accordance wit laws, rules and regulations of the State of Washington and the
Cit Y
r
Appfica s Sign tur Date "
Owner / Contractok/ wner's Agent / Co ractor's Agent (Please circle one.)
All permits are non - transferable and will expire if work authorized by such permit is not egun
gNwithin 180 days of issuance, or if work is suspended or abandon @iMK s
OCT
Q Y•
105 Yellin Avenue West (3fi0) 458 -3835
Yelm WA 98597 (360) 458 -3144 FAX
www.ci;yelm.wa.us