20170114 Permit Pkg 01242017Applicant:
City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Permit No.: 20170114
Issue Date: 1/24/2017
(Work must be completed within 180 days)
Name: DANIEL /MICHELL BUTLER Phone
Address: 15817 90TH AVE SE
YELM WA 98597
Property Information:
Site Address: 15817 90TH AVE SE Owner: DANIEL BUTLER
Assessor Parcel No.: 38330001100 Subdivision:
Contractor Information:
Name: BRENNAN HEATING Phone:
Address:
4601 S 134TH PL
SEATTLE WA 98168
Contractor License No.: 10111 Expires: 12/31/2017
Project Information:
Project: MECHANICAL
Description of Work: REPLACE GAS FURNACE AND INSTALL 2.5 TON HEAT PUMP
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
253 - 961 -5801
Fees:
Item
MECHANICAL
Contractor
BRENNAN HEATING
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 innt the �State of Washington. J) � �� i 7
Signature m QJl.trl,4�q�i "ice TC vLV Date 1 Ly "W 17
Firm
Lot:
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cite of Yolm
(36 j 458 -3244
RECD': 00257182 112412017 11:34 AM
OPER: CO TERM: 001
REFA' : 45622
PAID BY:
IRAN: 33,0000 BUILDING PERMITS
20170114 29,5CCR
BUTLER, DANIEL /MICEELL
15817 90TH AVE SE
MECH 29.5(CR
TENDERED: 29,50 CHECK.
APPLIED: 29.50-
CHANGE: 0,00
2k-) bi0 11 C4
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address:% `5s) q Q � ,AVV- (- S Parcel #: 3 833 00O I 1 00
Subdivision Lot # Plan #. Zoning.
El New Construction Re -Model / Re -Roof / Addition Home Occupation Sign
C! Plumbing � echanical Mobile / Manufactured Home Placement Other
Project Description i�- cope of Work nn epiQ (�. Q as U 1, n a ! c._ —+ '111 &�e_ I ( a /40 -[-o n
W / o n �" h -c &A- Q M?
Project Value: ty`? �
Building Area (sq. ft) 1" Floor 2 " Floor Garage Deck
Basement Carport Patio
# 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: y Ar -c r
ADDRESS , .S& EMAIL
CITY STATE ZIP TELEPHONE,2_'�3 • 0k
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 CONTRACTOR to a r1 TELEPHONE Ub • of y e Oo
ADDRESS y. O k S \'I 'P t_ EMAIL' t -t a7birC inJ A a. Go yY1
CITY STATE W a- ZIP 19 t b S FAX CL -A 8 `AA O5
CONTRACTOR'S LI ENSE # EXP AT _CITY LICENSE #
Copy of mitigation agreement with Yelm Co mu ty Schools, if applicable.
I he y c rt ify that the above information Is correct and that the construction on, and the occupancy and the use of the
a ve des ibed property will be in accordance with the laws, rules and regulations of the State of Washington and the
ity of Yel
/ I �-
pp cant's Signature ate
ner / Contractor / Owner's Agent / Contractor's Agent (Please circle one.)
All permits are non - transferable and will expire if work authorized by such permit
,J1 %Ireim.
2 31171
within 180 days of issuance, or if work 4s ppeqded or aban6I M a period of
city
Approved BY:_
105 Yelin Avenue West (360) •158 -3835
Yelm, WA 98597 JR� Z3 ► za t (360) 458 -3144 FAX
www.ci.yelrn.wa.us ----- —
Cib+4. Avc SE
WA,
otp - Dst --Mv
I-- in h4t 'DE
Z3 -7-0
Karen Bennett
From: Jaimie How Uaimie @brennanheating.com]
Sent: Friday, January 20, 2017 9A1 AM
To: Karen Bennett
Subject: Mechanical App
Attachments: butlermechapp. pdf
Importance: High
Please let me know the fee due once processed and ready for pick up.
Thank you,
Jaimie How
Permit Coordinator
Brennan Heating and Air
206.248.7900 office
877.273.6626 (toll free)
206.248.7905 fax