20170242 Permit Pkg 06292017of T City of Yelm kN
VACommunity Development Department
Building Division
Phone: (360) 458 -8407
LM
Fax: (360) 458 -3144
Applicant:
Name: DERRICK & JENNI GRASTY
Address: 16619 91 STAVE SE
YELM WA 98597
Property Information:
Site Address: 1 RR1 Q 41ST AVF AF
Permit No.: 20170242
Issue Date: 6/29/2017
(Work must be completed within 180 days)
Phone: 360- 960 -8887
Owner: JENNIFER GRASTY
Assessor Parcel No.: 63540007300 Subdivision: MOUNTAIN SUNRISE, DIV. II Lot: 73
Contractor Information:
Name: AMERICOOL HEATING
Address:
17929 IRWIN RD SW
ROCHESTER WA 98579
Contractor License No.: 10048
Phone:
Expires: 12/31/2015
Project Information:
Project: MECHANICAL
Description of Work: ADD ON HEAT PUMP. DUCT TEST REQUIRED. COPY TO CITY OF YELM BLDG DEPT
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
AMERICOOL HEATING
TOTAL FEES:
Applicant' Affidavit:
I certify thaf I have read and examined the information contained within the application and know the same
to be true nd correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regu
ti( inc udin those governing zoning and land subdivision, and in addition, all covenants,
easement an restrictio of record. If plying as a contractor, I further certify that I am currently
registered in t tate W s
Signature A Date
Firm lLIA A .0 •e�
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cite of Yelm
(36 ) 458-3244
RECD: 00273243
6/29/2017 4-:12 PM
OPER: CO TERM:
001
REFS: 9665
PAID BY:
TRAM: 33.0000
BUILDING 5(CRII,
20170242
GRASTY,
DERRICK & J[NNI
16619 91ST
AVE
MECH
29 5(CR
1E:NDERED: 29.50 (HECK.
FPPLIED: 29.50 -
CHANGE: 0.00
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 16619 91st Ave SE
Parcel #: 63540007300
Subdivision, MOUNTAIN SUNRISE Lot #: LT 73 Plan 4: Zoning:
New Construction Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing X Mechanical Mobile / Manufactured Home Placement Other
Project Description /Scope of Work: Add on Heat Pump
Project Value' 6268,00
Building Area (sq_ ft) 1V't Floor 968 2 1'd Floor 1481 3fd Floor Garage -2 car 3 car
Covered Patio 100 Covered Porch 30 Patio 100 Deck
# Bedrooms #t Bathrooms 2 5 Heating: GAS /OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? No
If yes, a completed environmental checklist must accompany permit application.
J"N8R;N kE: Jennifer Grasty
ADDRESS 16619 91st Ave SE EMAIL
CITY Y91m STATE wA, ZIP 98597 TELEPHONE 253- 985 -1482
IW1R LICENSE #
ADDRESS _ EMAIL_
CITY STATE ZIP TELEPHONE
, t: tTkA,C` 0R. TELEPHONE v
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
C3iJI�1IAGTOR TELEPHONE
ADDRESS EMAIL _
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
I tGt i 'TOR Americool Heating TELEPHONE 360 -27 -
ADDRESS 17929 Irwin St. SW EMAIL Jeannieaamericoolusa.com
CITY Rochester STATE WA ZIP 93579 FAX 360- 273 -3337
CONTRACTOR'S LICENSE #-M EXP DATEimm -,CITY LICENSE## 17 -loo48
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 Yalm_
6/101/17
A pl ant's Signature Date
O er / Contractor! Owner's Agent I 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 YOm Auen.ue West
Yelm, WA 9'SS91'
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(3K0) �i 2144 FAX
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HEATING & AIR CONDITIONING
17929 Irwin St SW
Rochester, WA 98579
(360) 273 -3300 or (360) 748 -6169
(360) 273 -3337 Fax
TO:I�
ATTN:
FAX: 8 D
FROM: Jeannie
NUMBER OF PAGES: �
(INCLUDING COVER PAGE)