20170167 Permit Pkg 04102017City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458 -3144
Applicant:
Name: NORTHWEST FAMILY HOMES
Address: PO BOX 39
EAST OLYMPIA WA 98540
Property Information:
Site Address: 10761 PALISADES ST SE
Assessor Parcel No.: 67110001700 Subdivision
Contractor Information:
Name: NORTHWEST FAMILY HOMES
Address:
PO BOX 39
EAST OLYMPIA WA 98540
Contractor License No.: NORTHFH954BE
Project Information:
Project: NEW RESIDENTIAL BUILDING
Description of Work: LOT 17, PLAN 2978
Permit No.: 20170167
Issue Date: 4/20/2017
(Work must be completed within 180 days)
Phone: 360- 791 -5644
Owner: NORTHWEST FAMILY HOMES
PALISADES WEST Lot: 17
Expires
Phone:
1/05/2017
Sq. Ft. per floor:
Heat Type (Electric, Gas, Other):
First
1367
Second
1602
Third
Garage
714
Basement
Fees:
Item
Contractor
Fees
NEW RESIDENTIAL BUILDING
NORTHWEST FAMILY HOMES
$23,312.46
MECHANICAL
SUNSET AIR INC
$ 78.25
PLUMBING
ACME PLUMBING
$ 125.00
TOTAL FEES:
$ 23,515.71
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 in the Sta of W hingto i
Signature Date
Firm M wet 1. -e,
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cite of Mm
(36 ) 458 -3244
RECD: 00266551 4/20/2017 3:17 PM
OPER: AS TERM: 001
REFS: 044
PAID BY:
TRAM: 33.0000 BUILDING PERMITS
20170167 23,515.7'CR
NORTHWEST FAMILY HOPES
10761 PALISADES ST .E
BLD -RES1 23,312.4ECR
MECH 78.2 CR
F'L 125.0(CR
TENDERED: 23,515.71 (HECK.
APPLIED: 23,515.71-
CHANGE: 0.00
W ' `x
7
CITY OF YELM
RESIDENTIAL BUILDING AERMDTAPPLICATtUN FORM
Project Address..J I Po i_I to � 4?1 .r+ S� Parcel#: � � ) 0 f 7 00
Subdivls1vr► C ��. t .I Plan �: �' `7 Zoninq;
—
X New ConstwGfion I r Re.*Model I Re -Roof ! Addifion �..� norr►e ucG� at�on S
Plumbing < < Mechanical ;:I Mobile I ManufaCtUred Herne Place m-ent � i ; Other
Project Desception/Scope of W vt ��r� �i7 N ew rPt2-,
Project Value:
0
Sulldfng Area (sq. ft) I rt Floor _ 3 (� end
Basement
# Bedrooms # Bathrooms __V
Are there any environmentafly sensitise areas
IfYfls, a completed environmental checklist m
BUILDING OXINER NAME.iy
ADDRESS i � , ii a J( ?
Garage Deck .�.�
Carport pati��- v � `8 0
Heating: AS T-N ER or ELECTRIC (Circle One)
Located on the parcel?
ust accomPany permit application_
m �
EMAIL
ciir�Rrt �ilvun�s`cSTATE�rT Zlp�` a TELEPHONE
..___
ADDRESS `''• /�COR �;�NSE# 170%� E - MAIL
GITY:ILPA STATE-&JA ZIP
1. L TELEPHONE
GENERAL CONTPACTOR
ADDRESS or - W f?o A -Ze�
CITY 0
Zy" pi_-V
CONTRACTOR'S
Wnfk% ul i41
hk e
i'ELEPHONE :100 - 711
�Z(P ! y
EMAIL Vj'k 7/77.-, ���y�.�Iiaivv4'ci0'�.NE�
'H STATE
CENSE # EkASy /?r EXP DACE Ciry "ecnie� u
PLUMBING CONTRACTOR iviY� d/p�t
ADDRESS 173+ Pin�itCv{- E
CITY Ot4 - yti y— �% A —' STATE W,r4 ZIPS
CONTRACTOR'S LICENSE ACft-- OR& qq 7 1
MECHANICAL CONTRALTO
ADDPPR.q C�trr-j (.1 r
Vet lh)r-
-11s,
t?fi1 tr TELEPHONE S
W. EdNfth�.
EMAIL
"1J FAX
EXP DATE CITY LICENSE-4
�J
TELEPHQNE,�y_1'r-&�. tl��
vv r iR v roc
CITY 4 � � rsrATE Lk./4 � ZIP q05761j...J=AX
'CONTRA 'S L CTO lCENSE # WJ E Zzvo EXP [)ATE
�CtTY LICENSE
Cvpy of Miggaflvn agreement with Ye Im Commu try SCIlvols., if ��p��Cab�e.
! hereby certify that the above iryfcrrpatlon is cnrrQct end that the canstructivn c�n� and Ehe occupancy at�d the use
above de-scribed property �r11F be in accordance with the #aws. rates and regutattans aF the State v� 1Nash�n Eon of the
City oi` Yetms e end �h�
IL
Applicant's Signature
Owner i Contractor 1 owner's AgOnt I Contractor's Agent (Pleasp �-�� D ate
All peri its are nvn iransferal)ie and w
within 160 days of issuance, or if work
l�
106 -yebrit Avenue
Yrar,,, WA 9W.97
ft! expire it work authorized by such perrni t is o egun
is suspended or abandoned for a Period of 1130 days
(3G0 ) 455 -3836
(866) 4684.144 PAX