20170226 Permit Pkg 06082017City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: JOANNE WOLF
Address: 203 MOSMAN AVE SE
YELM WA 98597
Property Information:
Site Address: 203 MOSMAN AVE SE
Assessor Parcel No.: 22719332100
Contractor Information:
Name: JOANNE WOLF
Address:
203 MOSMAN AVE SE
YELM WA 98597
Contractor License No.:
Project Information:
Project: MECHANICAL
Description of Work:
REPLACE GAS FURNACE
Sq. Ft. per floor:
First
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Permit No.: 20170226
Issue Date: 6/08/2017
(Work must be completed within 180 days)
Phone: 360- 458 -5998
Owner: JOANNE WOLF
Subdivision: Lot:
Phone:
Expires: 0 /00 /0000
Heat Type (Electric, Gas, Other):
Contractor
BLACK HILLS, INC
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 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 / ,, ,/' Date C ; o,
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cite of Y�lm
(36.) 458 -3244
RECD: 00271142 6/08/2017 11:27 AM
OPEF' : CO TERM: 001
REF11: 18519
PAID BY:
TRAM: 33.0000 BUILDING
29 PiRMIT3
20170226
WOLF, JOANNE
203 MOSMAN AVE 29 5(CR
MECH
1ENDERED:
29.50 (HECK
APPLIED:
29.50 -
CHANGE : _ __
_ 0.00
CITY OF YELM
,,�� 22RESMIDENTIAL BUILDING ,P,ECRMIT APPLICATION FORM
Project Address�U� (n I OSMCn aU6' .Parcel #: I!a ?J3a 1 no
Subdivision:
Lot #: Plan #: Zoning:
New Construction - Re -Model / Re -Roof / Addition �] Home Occupation Sign
Plumbing Mechanical * Mobile / Manufactured Home Placement Other
Project Description /Scope of Work:
(( V �k�IC�.C2� • mod' 0
Project Value: ` 000
Building Area (sq. ft) 1" Floor 2nd Floor 3'd Floor -
Covered Patio Covered Porch Patio
Garage -2 car 3 car
Deck
# Bedrooms_ # Bathrooms_ Heating: GAS /OTHER 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 NAME: D
ADDRESS EMAIL
CITY hr\ STATELQPk- _ZIP TELEPHONE (0.0
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRPC' OR �`fiE7EEPHONE -' O - 5 O
ADDRESS `� �' EMAIL Susan c,.c t M U-,c . Gam
CITY STATE P ZIP Se I FAX
CONTRA T R'S LICENSE #ALLA-(-"_Lb(tL EXP DATE CITY LICENSE # (5oL OQUaSCp
'1 [1,1[1-7
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 Yelm.
by 4
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
105 Yelm Avenue West (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.yelm.wa.us
From:Black Hills Inc
360 705 8584 06/06/2017 11.39 #032 P.001 /007
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address�CL-> t I M t OSMCi_� - Parcel #: `� Ig S5 Q-1 00
Subdivision: Lot #: Plan #: Zoning:
New Construction Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing Mechanical Mobile / Manufactured Home Placement C1 Other
Project Description /Scope of Work: 1 ckt 4 _-, 9� I Q
Project Value: ` CLIO +' ,,f'
Building Area (sq. ft) 1St 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?
lfyes, a completed environmental checklist must accompany permit application.
ADDRESS S 1 [ l��tY�i. I� C� EMAIL _
CITY � STATE WA_ZIP Q`5�{i TELEPHON
ARCHITECUENGINEER LICENSE #
..............
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR
TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR
ADDRESS
CITY STATE ZIP
CONTRACTOR'S LICENSE #
MECHANICAL CONTRAC J UI
ADDRESS
CITY CU STAT
CONTRAST R'S LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
..D UV TELEPHONE
EMAIL `ukSars Q
i 6 t FAX
EXP DATE_ CITY LICENSE #
13 L, 'I tt 'R tt-1
Copy of mitigation agreement with Yelm Community Schools, if applicable.
.0
c,Orn
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 Yet,.
4
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
p L9QM sIE
Y05 Yelm Avenue West J V 17 1 (360) 4.58 -3835
Yelm, WA 98597 (360} 458 -3144 FAX
wwrc.ci.yelm.wa.us BY ....................