20170152 Permit Pkg 03282017City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: PHILIP - SHELLY KUJAWA -REYES
Address: 14939 MTN VIEW CT SE
YELM WA 98597
Property Information:
Site Address: 14939 MTN VIEW CT SE
Assessor Parcel No.: 42990000600
Contractor Information:
Name: FAST WATER HEATER
Address:
11715 NORTH CREEK PARKWAY S.
BOTHELL WA 98011
Contractor License No.: FASTWWH948BC
Permit No.: 20170152
Issue Date: 3/28/2017
(Work must be completed within 180 days)
Phone: 360- 485 -3909
Owner: PHILIP - SHELLY KUJAWA-
REYES
Subdivision: COUNTRY VISTA Lot: 6
Phone: 425 - 814 -3124
Expires: 1/04/2021
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 Affidavit:
certify that I have read and examined the information contained within the application and know the same
to be true and c rrect. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulatio s including those governing zoning and land subdivision, and in addition, all covenants,
easements an re ri rd. If applying as a contractor, I further certify that I am currently
registered in t o t M7ash' ton. z
Sig nature 4 Date �/ A I
Firm 4�l Q f,(
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Citt of Mm
(36 i) 458 -3244
RECD': 00263931 3/28/2017 4:21 PM
OPER: CO TERM: 001
REFS`: 22343
PAID BY:
TRAM: 33.0000 BUILDING 29.5(CRII3
20170152
KUJAWA- REYES, PHILIF- SHELLY
14939 MTN VIEW CT SE
MECH 29.5(CR
TENDERED: 29.50 (HECK.
APPLIED: 29.50-
CHANGE: 0.00
IV 1 rl-U +*1
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM b �
Project Address: � qq 3 9 ! U 00 N rl 1 N V I'' Parcel ��Q 2 � n 000J -oQb
Subdivision: Lot #: Plan #: Zoning:
&1'7015-'7--
Q` 507-
E New Construction Re -Model / Re -Roof / Addition i Home Occupation Sign
E Plumbing Mechanical I I Mobile / Manufactured Home Placement i Other
Project Description /Scope of Work: �P � ���� �� �� ��AS LA.) a- w ki o-4tly
Project Value: ,$
Building Area (sq. ft) 1St Floor 2nd Floor 3rd Floor Garage -2 car 3 car
Covered Patio Covered Porch Patio Deck
# Bedrooms_ # Bathrooms_ Heatin OGAS/ TH ER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? K D
If yes, a completed environmental checklist must accompany permit application.
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C CTOR'S LICENSE # EXP DATE CITY LICENSE #
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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" -�
Applicant's Signature Date
Owner l' 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 d
UU MAR 2a? Nil'
105 Yelm Avenue West
_____._...._
Yelm, WA 9897
.5
(360) 458 -3144 FAX
www.ci.yelm.wa.us