20170134 Permit Pkg 03062017City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: BILLEE LEVETON
Address: 10414 BRIGHTON ST SE
YELM WA 98597
Property Information:
Site Address: inAld RRIC.HTON ST SF
Assessor Parcel No.: 65080009700 Subdivision:
Contractor Information:
Name: BLACK HILLS, INC
Address:
1003 85TH AVE SE
OLYMPIA WA 98501
Contractor License No.: BLACKH1066JL Expires
Permit No.: 20170134
Issue Date: 3/06/2017
(Work must be completed within 180 days)
Phone: 757- 876 -9835
Owner: BILLEE LEVETON
Lot:
Phone: 360 - 239 -3776
3/31/2017
Project Information:
Project: MECHANICAL
Description of Work: REPLACE 50 GALLON HOT WATER TANK
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:
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 the State of Washington.
Signature ��� .✓ Date3 6 — 2,07
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cite of Nm
(361) 458 -3244
REW 00261575 3/06/2017 12 :47 PM
OPER: AS TERM: 001
REW 18177
PAID BY:
TRAM: 33.0000
20170134
LEVETON
10414 Bf
MECH
BUILDING PERMITS
29 0 CR
BILLEE
IGHTON ST SE
29.5(CR
TENDERED: 29.50 (HECK
APPLIED: 29.50-
CHANGE: 0.00
zoI -[D 13 4
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: � [41 L i I htof) 'S--t Parcel #: `CSC,. 3 �Dt i+'�
Subdivision:
Lot #: Plan #: Zoning:
!- New Construction L Re -Model 1 Re -Roof / Addition Home Occupation Sign
,_!Plumbing Mechanical Mobile / Manufactured Home Placement Other
Project Description /Scope of Work: VC-'p 1 QGC G C ria— (C)P\ hot- L- "," ``' {� °� K—
Project Value: 1 2—
Building Area (sq. ft) ,15t 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?
(f yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME:
ADDRESS
EMAIL
CITY STATE ZIP TELEPHONE
ADDRESS
CITY STATE ZIP
LICENSE #
EMAIL
TELEPHOI`
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
ADDRESS CONTR MA 13 i VIZ MAIL JC
{ 115 it lc- ENEU �hlaci
CITY ( iI i(l a r_STATE 1 < Z!P ���0 i FAX
CONTRACTOkS LICENSE EXP DATE3_12 ,CITY LICENSE # i Lo I C091
MECHANICAL CONTRACTOR TELEPHONE _
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
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 Yelm.
Applicant's Si ature Date
Owner t Contractor ! Owner's Agent / Contractor's Agent (Please circle one.)
All permits are non - transferable and will expire if work authorized by such perm F(m
within 180 days of issuance, or if work is suspended or abandoned for a period a
^. A -,
105 Yelm Avenue West
Yelm, WA 98597
www.ci.yelm.wa.us
BY-- --------------- - - - --
(360) 458 -3835
(360) 458 -3144 FAX
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