20170125 Permit Pkg 02132017Oc THE p
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: SHERRY LANDON
Address: 16139 PALOUSE AVE SE
YELM WA 98597
Property Information:
Site Address: 16139 PALOUSE AVE SE
Assessor Parcel No.: Subdivision:
Contractor Information:
Name: FAST WATER HEATER
Address:
11715 NORTH CREEK PARKWAY S
BOTHELL WA 98011
Contractor License No.: 10236
Permit No.: 20170125
Issue Date: 2/13/2017
(Work must be completed within 180 days)
Phone: 360- 458 -8509
Owner: SHERRY LANDON
Phone:
Expires: 12/31/2017
Project Information:
Project: MECHANICAL
Description of Work: REMOVE AND REPLACE GAS WATER HEATER
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
FAST WATER HEATER
TOTAL FEES:
Applicant's ffidavit:
I certify that have read and examined the information contained within the application and know the same
to be true a d correct. I also c!rtify t the proposed structure is in conformity with all applicable City of
Yelm regul ions incl diagfF�ose gov Wing zoning and land subdivision, and in addition, all covenants,
easements nd res igtio s of recor . If applying is a c tractor, I further certify that I am currently
registered i the St t of �hi /ngIt
Signature / V I ITak Date 7' ��'' /
Firm
Lot:
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Clt�' Of Mm
{36 �) 458 -3244
REC#: 00259551 211312017 4 -:53 PM
OPER: CO TERM: 001
REFS': 22171
PAID BY:
TRAM: 33.0000 BUILDING PERMITS
20170125 29.5CCR
LANDON, SHERRY
16139 PALOUSE AVE SF
MECH 29.51CR
TENDERED: 29.50 CHECK
APPLIED: 29.50 -
CHANGE: 0.00
I I l.� M1l sq� CITY OF YELM
I RESIDENTIAL BUILDING PERMIT APPLICATION FORM I �
Project Address: � � �T I ��� AI � � Parcel #: �� 000,00
Subdivision: Lot #: Plan #: Zoning: O\
E New Construction Re -Model / Re -Roof / Addition Home Occupation Sign `
C Plumbing Mechanical Mobile / Manufactured Home Placement Other
Project Description /Sconpeccof Work: 9E MP VC-16e I2I ii tl �—
Project Value: I J
Building Area (sq. ft) 1St Floor 2nd Floor 3rd Floor Garage -2 car 3 car
Covered Patio Covered Porch Patio Deck
# Bedrooms_ # Bathrooms_ Heatin (GAS/ THEIR 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 N l� " >'
ADDRESS 1, Na EMAIL --
CITY STATE LVFI ZIP TELEPHONE 0 j
,4d±
E#
ADDRESS AIL
CITY STATE ZIP TELEPH
ADDRESS EMAIL
CITY TE ZIP
C R'S LICENSE # EXP DATE
PLUMBING CONTRACTOR- -
ADDRESS
CITY STATE
CDNT 7KC-TOR'S LICENSE #
TELEPHONE
SE #
ZIP FAX
EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR SST W �KEi17' TELEPHONE
ADDRESS I k C EMAIL LKE Ht, f LA .1tter -•_
CITY 6 11 STATES ZIP D 1 ( FAX
CONTRACTOR'S LICENSE #fA9kJW4tgV &3 C EXP DATE-,�- CITY LICENSE # - (o
I - t -(- s
Copy of mitigation agreement with Yelm Community �chools, 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 Yelm.
VN" "�,UA C) - - (-
Applicant's Signature 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 180 days )asE
D
E9TP,T VV S;1
FEB -- 0201171
105 Yelm Avenue West p (360) 458 -3835
Yelm, WA 98597 BY:-- (469 }4464- 8 #44-FA*
www.ci.yelm.wa.us