20160359 Permit Pkg 11142016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: JUNE CHERRY
Address: 10346 PARKVIEW LP SE
YELM WA 98597
Property Information:
Site Address: in'lAR PARK\ /IGW I D CP
Assessor Parcel No.:
Contractor Information:
Name: BLACK HILLS, INC
Address:
1003 85TH AVE SE
OLYMPIA WA 98501
Contractor License No.: BLACKH1066JL
Subdivision:
Permit No.: 20160359
Issue Date: 11/14/2016
(Work must be completed within 180 days)
Phone:
Owner: JUNE CHERRY
Lot:
Phone: 360- 239 -3776
Expires: 3/31/2017
Project Information:
Project: MECHANICAL
Description of Work: REPLACE 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 an restrictions of record. If applying as a contractor, I further certify that I am currently
registered i t State of Washington.
Signatur Z / Date w 6
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
TI f of Yelm
j 458 -3244
REC4': 00249845 11/14/2016
S` 1
11;32 AM
OPER: 7 TERM: 001
REF #: 17744
PAID By:
TRAM: 33.0000 BUILDING PERMITS
20160359 29.5(CR
CHERRY, JUNE
10346 PARKVIEW LP SE
hIECH 29.5(CR
TENDERED: 29.50 CHECK
APPLIED: 29.50-
CHANGE:
From:Black Hills Inc 360 705 8584 11/14/2016 10:39 #727 P.002/003
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM?
Project AddressA ,,,l it Parcel #:
Subdivision: Lot #: Plan #: Zoning:
=1 New Construction Re -Model / Re -Roof / Addition C:: Home Occupation Sign
Plumbing Mechanical Mobile / Manufactured Home Placement Other
Project Description /Scope of Work:'f / i'3 - + I r ' ' V�' �E' �( r
Project Value: i V
Building Area (sq. ft) 157 Floor 2nd 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.
BQILDING OWNER NAME:: ?
AD?RESS A , ". EMAIL
CITY( _STATE ZIP TELEPHONES 5'[�
1 AR:CHITECTIENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
YLUMBINCs "GpN'I KAL,1.UK I LLL= 'HUNL
ADDRESS EMAIL
1 CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CO NT CT OR j ' \f. «i )` I TELEPHONE ! L'Z; q_51_770
ADDRESS J� EMAIL
CITY STATE ZIP gull FAX ;
CONTRA O 'S LICENSE # G7' f 9R � 7,Q,LM�- EXP DAT CITY LICENSE # ,fit `1 DO' i
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 yM1-.,be in accordance with the laws, rules and regulations of the State of Washington and the
C q#Yelm.
F jj�
p ;s�rtf's�5ignat re , Da e s
Owner / Contractor#/ Owner's Agent 1 Contractor's Agent (Please circle one.)
All permits arkngh- 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 d V 7
NOV 4 2016
105 Yelm Avenue West (360 X3835 ......
Yelm, WA 98597 (360) ��3t��i�Ai"
www.cl.velm.wa.us