20170247 Permit Pkg 06212017City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: SUSANNE MILLS
Address: 9944 JENSEN DR SE
YELM WA 98597
Property Information:
Site Address: AAAA .IFNRFN nR RF
Assessor Parcel No.: 78640106200
Contractor Information:
Name: BLACK HILLS, INC
Address:
1003 85TH AVE SE
OLYMPIA WA 98501
Contractor License No.: 10091
Project Information:
Project: MECHANICAL
Description of Work:
INSTALL AC UNIT
Sq. Ft. per floor:
First
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Permit No._ 20170247
Issue Date: 6/2112017
(Work must be completed within 180 days)
Phone: 253 - 405 -5727
Owner: SUSANNE MILLS
Subdivision: TAHOMA TERRA
Phone:
Expires: 12/31/2016
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 % —Z ( —Zvj 7
Firm
Lot: 62
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cit� of
(36�) 458 -3244 Yelm
RECt: 00272902 6/21/2017 1:15 PM
OPER: CO TERM: 001
REFt: 18570
PAID BY:
TRAM: 33.0000 BUILDING PiRMIT3
20170247
MILLS, SUSANNE
9944 JENSEN DR 29 5(CR
MECH
TENDERED: 29.50 (NECK
APPLIED: 29.50-
CMANGE: 0.00
From:Black Hills Inc 360 705 8584 06/21/2017 07:47 #f087 P.002 /003
20iIV2 y7
CITY OF YELM
PRESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address t - ! 4 ` yy y Parcel #:.2b �`t��! (C(2
Subdivision: Lot #: Plan #: Zoning:
Cl New Construction Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing Mechanical ,I Mobile / Manufactured Home Placement Other
Project Description/Scope of Work:
Project Value: I'D
Building Area (sq. ft) 15` 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?
1f yes, a completed environmental checklist must accompany permit application.
MECHANICAL CON RAQT" R I 1 i LEPHONE
ADDRESS ` ����� �� EMAIL
CITY ? STATE ZIP 11V FAX
CONTRACYOR'8 LICENSE # CKh10Ufr< L_EXP DATE I I "Y LICENSE AU 't C-0711—
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.
CN;�,JtCA t\
Applicant's Si nature Date
Owner i C ntr ctor I 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 0 Im i
!UN 2 1 2017
105 Yelrn Avenue West
Yelm, WA 35537
www.ci.veim.wa.us
(360) 8335
(360) 5 - 3144�'�i��•••�•••••••