20160347 Permit Pkg 10202016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: AMY GILLESPIE
Address: 8920 LEALAN CT SE
YELM WA 98597
Property Information:
Site Address: RQ7f1 I G A l Am f`r cc
Assessor Parcel No.:
Contractor Information:
Name: BLACK HILLS, INC
Address:
1003 85TH AVE SE
OLYMPIA WA 98501
Contractor License No.: BLACKH1066JL
Subdivision:
Permit No.: 20160347
Issue Date: 10/20/2016
(Work must be completed within 180 days)
Phone: 360- 481 -7100
Owner: AMY GILLESPIE
Lot:
Phone: 360- 239 -3776
Expires: 3/31/2017
Project Information:
Project: MECHANICAL
Description of Work: REPLACE HEAT PUMP AND GAS FURNACE. DUCT TEST REQUIRED
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
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 restrictio s of record. If applyi as a contractor, I further certify that I am currently
registered in the shington.
Signature Date —
Firm K 1 , 1 r
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cite of Yell
(361) 458 -3244
RECV 00247608 10/20/2016 2:05 PM
OPER: CO TERM: 001
REEF: 17683
PAID BY:
TRAM: 33.0000 BUILDING P[RMIW
20160347
GILLESPIE, AMY
8920 LEALAN CT 29 5CCR
MECH
TENDERED: 29.50 ( HECK.
APPLIED: 29.50 -
CHANGE: _ 0.00
From:Black Hills Inc
360 705 8584 10/20/2016 09:28 #565 P.002/004
p `0
CITY OF YELM�
RESIDENTIAL BUILDING PERMIT APPLICATION FORM t
Project Address: ', `� -- �$ c 11 C_, � Parcel #:
Subdivision: Lot #: Plan #: Zoning:
New Construction Re -Model / Re -Roof / Addition Home Occupation Sign
t"',. Plumbing ><3Aechanical Mobile / Manufactured Home Placement _j Other
Project Description/Scope of Work:
Project Value: � V I y; 1
vO't
li 4- 2- d
Building Area (sq. ft) 1" 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?
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: Tft ,J ! _
ADDRESS 61.2D .I EMAIL
CITY )1d,1M STATE(` s( ZIP TELEPHONE -1
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTR��.;,�C OR I k TELEPHONE s ; ` 'r'''
ADDRESS 1j `a'�": EMAIL i I�,'
CITY i L� STATE.''.' .rZIP '�S FA r (fit)/ j�
CONTRA T R'S LICENSE #B '�#1 GVi; ja —EXP DATE I i I Y LICENSE # ,,Z— 10&
Copy of mitigation agreement with Yelm Community Schools, if applicable.
ky certify that " a2love information is correct and that the construction on, and the occupancy and the use of the
described property ON, be in accordance with the laws, rules and regulations of the State of Washington and the
Cox
WINN,
Ap n s Sinat r Date
Owner I Contr cto / Owner's Agent / Contractor's Agent (Please circle one.)
All permits are non - transferable and will expire if work authorized by such Perm i ' VTC
within 1$t3 days of issuance, or if work is suspended or abandoned for a period o A� nn cc IOCT
Bye •w.www.wwwwwwwwwwwwww
105 Yelm Avenue West (360) 458 -3835
Yelm. WA 98597 (360) 458 -3144 FAX
u;wic.cz.yelm.wa.us
From:Black Hills Inc 360 705 8584 10/20/2016 09:29 #565 P.004/004
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