20170183 Permit Pkg 05102017o! TURA City of Yelm
VAI Community Development Department
Building Division
Phone: (360) 458 -8407
L
Fax: (360) 458 -3144
Applicant:
Name: MARK LAVERGNE
Address: 1314 169TH ST S
SPANAWAY WA 98387
Property Information:
Site Address: 1f1F vm M AVF W
Assessor Parcel No.: 85800100100 Subdivision:
Contractor Information:
Name: MARK LAVERGNE
Address:
1314 169TH ST S
SPANAWAY WA 98387
Contractor License No.:
Permit No.: 20170183
Issue Date: 5/10/2017
(Work must be completed within 180 days)
Phone: 360- 915 -4944
Owner: MARK LAVERGNE
Phone:
Expires: 0 /00 /0000
Project Information:
Project: MECHANICAL
Description of Work: INSTALL MINI SPLIT HEATER AND AC
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
MARK LAVERGNE
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 includin those governiN zoning and land subdivision, and in addition, all covenants.
easements an a ri on of re rd. If lying a contractor, I further certify that I am currently
registered in/le e of ash' gton
Signatur Date 67—/0— '
Firm
Lot:
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cite of Yelm
(36) 458 -3244
RECA: 00268585 5/10/2017
OPEP: CO TERM: 001
REFS:
PAIE BY:
TRAM: 33.0000
20170183
LAVERGNE,
106 YELM
MECH
TENDERED:
APPLIED:
1:12 PM
BUILDING PERMII3
29.5(CR
MARK
AVE W
29.5(CR
30.00 (ASH
29.50-
CHANGE: 0.50
ASHINGTON
BUILDING PERMIT APPLICATION
❑ New Construction (SFR) ❑ Remodel
- OVechanical
❑ New Construction (Duplex) ❑ Addition
1� Commercial
❑ New Construction (Multi - family) ❑ Reroof
❑ Tenant Improvement
❑ Manufactured Home Placement ❑ Plumbing
❑ Fire Permit
Property Address: 16C, VI&IM R V v
Tax parcel number: Subdivision:
Lot No.:
Project Description /Scope of Work: ^jn n ISP I 1�Q�
Project Valuer Heat Source:
❑ Gas Electric ❑ Solar
Plan No.: Bedrooms: Baths:
Area 1St Floor: 2nd Floor:
3rd Floor:
Garage: Basement:
Carport:
Covered Patio:
Front Porch:
Applicant: ��(� � ��'� �.� Owner:
Address: Address:
I3►� 11v�� S��
paf 0
Telephone: Telephone:
"? 0.- Q [ l,�S /( , �t�elr <
Email: Email:
,
Architect /Designer: General:
Address: License No.:
Telephone: Telephone:
Email: Email:
Plumber: Mechanical:
Email: Email:
MAY
License No.: License No.:
BY:________________
by submitting this application to the City of Yelm, you affirm that all answers, statements, and information
_. contained in and submitted with this application are complete and accurate to the best of your knowledge and
that you are the owner of the property or duly authorized by the owner to act on their behalf. Permission is
granted to representatives of the City to enter upon and inspect the property as reasonably necessary to process
the application.
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