20170124 Permit Pkg 02132017City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: ROBERT PROKOPOWICZ
Address: 14850 100TH AVE SE
YELM WA 98597
Property Information:
Site Address: IAfZrn innTW AVG CG
Permit No.: 20170124
Issue Date: 2/13/2017
(Work must be completed within 180 days)
Phone:
Owner: ROBERT PROKOPOWICZ
Assessor Parcel No.: 78640013900 Subdivision: TAHOMA TERRA Lot: 139
Contractor Information:
Name: BOB'S HEATING & AIR Phone:
Address:
14148 NE 190TH ST
WOODINVILLE WA 98072
Contractor License No.: 10102 Expires: 12/31/2017
Project Information:
Project: MECHANICAL
Description of Work: LIKE FOR LIKE HOT WATER TANK REPLACEMENT
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
BOB'S HEATING & AIR
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 luding those governing zoning and land subdivision, and in addition, all covenants,
easements and r trictions of record. If applying as a contractor, I further certify that I am currently
registered in th to of gton. 7
Signature Date 3/7
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cite i) 4 of
X36 58 -3244 Yelm
RECD': 00259525 2/13/2017 1:45 PM
OPER: CO TERM: 001
REFS`: 600627
PAID BY:
TRAM: 33.0000 BUILDING 5(CRII3
2:0170124
PROKOPOWICZ, ROBERI
14850 100TH AVE SE
MECH
TRAM: 30.0000 BUSINESS LICENSE
17 -10102 BOBS HEATING W IRCL' OOCR
EmSINESS LICENSES &
I E.NDERED : 54.50 CHECK
APPLIED: 54.50 -
CHANGE: 0.00
,w),q0fo
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 14850 100th Ave SE Parcel #: 78640013900
Subdivision: Lot #: Plan #: Zoning:
i 1 New Construction ❑ Re -Model / Re -Roof / Addition i i Home Occupation Sign
u Plumbing X Mechanical Ll Mobile / Manufactured Home Placement a Other
Project Description /Scope of work: like for like hot water tank replacement
Project Value: 1800.00
Building Area (sq. ft) 151 Floor 2"d 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?
/f yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: Bob Prokopowicz
ADDRESS 14850 100th Ave Se EMAIL
CITY Yelm STATE—Wa-_ZIP 98567 TELEPHONE 360-402-1608
ARCHITECT/ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
dENSAW06 'RACTOR 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(NTITOR Bobs Heating TELEPHONE 800 -840 -3346
ADDRESS 14148 NE 190th EMAIL Ihoneycu o s eating.com
CITY Woodinville STATE WA ZIP 98072 FAX
CONTRACTOR'S LICENSE # ff0BbHHA853NQ EXP DATES /7/101TY LICENSE # 17 -10102
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 be In accordance with the laws, rules and regulations of the State of Washington and the
City of Y m.
Y
2/10/17
Ap611cant's Signature I I Date
Owner / Contractor / Owner'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 180 days of Issuance, or if work is suspended or abandoned for a period of 18` � M
0 1 3 �2V :0i7
1
t
105 Yelm Avenue West (360) 458- 38ff1`_
Yelm, WA 98597 (360) 458-3144 FAX
www.ci.yelm.wa.us `,