20170248 Permit Pkg 06302017City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: BARBARA LAIMONT
Address: 3701 PACIFIC AVE SE
OLYMPIA WA 98501
Property Information:
Site Address: 7ni MCvCMAN AVF CF
Assessor Parcel No.: 22719332000 Subdivision:
Contractor Information:
Name: BARBARA LAIMONT
Address:
3701 PACIFIC AVE SE
OLYMPIA WA 98501
Contractor License No.:
Permit No.: 20170248
Issue Date: 6/30/2017
(Work must be completed within 180 days)
Phone:
Owner: MAX LAIMONT
Phone:
Expires: 0 /00 /0000
Lot:
Project Information:
Project: MECHANICAL
Description of Work: REPLACE FURNACE, INSTALL AC AND GAS PIPE. DUCT TEST REQUIRE AND TURN
COPY OF TEST INTO THE CITY OF YELM.
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
BARBARA LAIMONT
TOTAL FEES:
Applicant's Affidavit:
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 ind 11 ose governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions f record. If applying as a contractor, I further certify that I am currently
registered i the t to of ashington.
Signature Date
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City, of Yolm
(36 1) 458 -3244
RECA: 00273306 6/30/2017 2:06 PM
OPER: CO TERM: 001
REFS: 2615
PAID BY:
TRAM: 33.0000 BUILDING PERMIIS
20170248 290CR
LAIMONT, BARBARA
201 MOSMAN AVE SE
MECH 290CR
1E:NDERED: 29.50 (HECK.
APPLIED: 29.50 -
CHANGE: 0.00
Ai7a08
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: vdll, MO&MaL NZ 6 Parcel #: 22� d �j�j U26
Subdivision: Lot #: Plan #: Zoning: _
New Constructio - odel / Re -Roof 1 Addition Horne Occupation Sign
Plumbing anical Mobile / Manufactured Home Placement Other
Project Description/Scope of�Work: CZ
Project Valuer
Building Area (sq. ft) 1"' Floor 2nd Floor,
ot
3`d Floor - Garage -2 car 3 car
Covered Patio .. Covered Porch Patio Deck
# Bedrooms # Bathrooms_ Heating GA OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on t parcel? yJZ)
!f yes, a completed environmental checklist must accompany permit application.
ADDRESS " ► CMHIL
CITY _STATE V\PA ZIP ln TELEPHONE= -- 2-"
^: LICENSE #_
ADDRESS EMAIL
CITY STATE ZIP TELEPHON
b lit TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
t ` , ; J�jlif t' TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
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CON A OR'S LICENSE #I"�Sn�Mq�!45IIEXP DAT CITY LICENSE #-
Copy of mitigation agreement with Yelm Community Schools, if applicable.
ME
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. , n
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 perind Lei 1 Za V VIP
S ?Y��
105 Xelm Avenue West (3 ) 4rS- -,R!94 5r----- -- - - - -M
yelm, WA 95597 (360) 458 -8144 FAX
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