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20160353 Permit Pkg 10312016A0C Z 'p City of Yelm �4 4 Community Development Department Building Division Phone: (360) 458 -8407 L Fax: (360) 458 -3144 Applicant: Name: TERRY COLE Address: 80 KUPALAOKI LOOP KIHEI HI 96753 Property Information: Site Address: Qmn nnNnVAN r_T CF Assessor Parcel No.: Contractor Information: Name: BLACK HILLS, INC Address: 1003 85TH AVE SE OLYMPIA WA 98501 Contractor License No.: BLACKHI066JL Subdivision: Permit No.: 20160353 Issue Date: 10/3112016 (Work must be completed within 180 days) Phone: 360- 456 -3745 Owner: TERRY COLE Lot: Phone: 360- 239 -3776 Expires: 3/31/2017 Project Information: Project: MECHANICAL Description of Work: REPLACE GAS FURNANCE 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 restrictions of record. If applying as a contractor, I further certify that I am currently registered in State of Washington. �{ Signature %� // Date (J Firm Fees $ 29.50 $ 29.50 OFFICIAL USE ONLY # Sets of Prints: Final Inspection: Date: By: City► of Yelm (36 0 458 -3244 REW 00248214 10/31/2016 12:06 PM OPER: CO TERM: 001 REEF : 17715 PAID BY: TRAM: 33.0000 BUILDING PERMITS 20160353 29.5(CR COLE, TERRY 9806 DONOVAN CT SE MECH 29 K CR TE:NDEREO: 29.50 (HECK. APPLIED: 29.50- CHANGE: 0.00 From:Black Hills Inc 360 705 8584 10/31/2016 10:20 #646 P.002/003 X0353 CITY OF YELM RESIDENTIAL BUILDING PERMIT APPLICATION FORM Project Address: ` g -'V t vl'ryo �,��! n ;J % Parcel #: `I 4 u"t 0,00,c Subdivision: Lot #: Plan #: Zoning: New Construction Re -Model / Re -Roof / Addition 7 Home Occupation Sign Plumbing Mechanical 71 Mobile / Manufactured Home Placement -. Other Project Description /Scope of Work: u { S n a.cz, Project Value: Building Area (sq. ft) 15t Floor 2nd Floor 3`d Floor Garage -2 car 3 car Covered Patio Covered Porch atio Deck # Bedrooms_ # Bathrooms_ Heating: G /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. ADDRESS 0WIX 12 LTM CITY \11 I AM STA EMAIL — P sit TELEPHON 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 I CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE # MECHANICAL CONTRACTOR ;SIR _ -1tit , 111.E TELEPHONE 1 0 ADDRESS 003 EMAIL - CITY T.OSTATE��� ZlP sir FAX . CONTRAC O S LICENSE # i°cGK1�tGUQ�' EXP DAT ti .1fY LICENSE #'�1�lt1(.� 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 in accordance with the laws, rules and regulations of the State of Washington and the City Rf Yelm. ---"'� =e Lei A P'o Iff eant q Signature Date Owner / Contractor / Ow r'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 480 days of issuance, or if work is suspended or abandoned for a periV OCT -, 12016 105 Yelm Avenue West (3 S S -_3J a .............. Yelnt. WA 98597 (360) 458 -3144 FAX www.ei.velm- .wa.us