20170284 Permit Pkg 08082017City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: ELLISON & STEPH HUNT
Address: 14709 91 ST AVE SE
YELM WA 98597
Property Information:
Site Address: 1A7f1Q Q1 AT AVF CF
Assessor Parcel No.: 33860005100
Contractor Information:
Name: BLACK HILLS, INC
Address:
1003 85TH AVE SE
OLYMPIA WA 98501
Contractor License No.: 1610091
Permit No.: 20170284
Issue Date: 8/0812017
(Work must be completed within 180 days)
Phone: 910- 527 -6335
Owner: STEPHANY HUNG
Subdivision: BELLA HOUSA
Lot: 51
Phone: 360- 239 -3776
Expires: 12/31/2017
Project Information:
Project: MECHANICAL
Description of Work: INSTALL AC UNIT. DUCT TEST REQUIRED. COPY TO THE CITY OF YELM
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
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 �/a �o'— Date 8/6/(
Firm
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cit�l of Yeti
(36 0 458 -3244
RECA: 00277515 8/08/2017 10:05 AM
OPER: CO TERM: 001
REFS: 18768
PAID BY:
TRAM: 33,0000 BUILDING PERMIT'S
20170284 29.5(CR
HUNT, ELLISON & STEFH
14709 91ST AVE SE
MECH 29.5(CR
1E:NDERED: 29.50 (HECK
APPLIED: 29.50-
CHANGE: 0.00
From:Black Hills Inc 360 705 8584 08/07/2017 15:52 #274 P.002/003
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: `'" I S �4 Parcel #: �� 1 D
Subdivision:
Lot #: Plan #: Zoning:
�b%� Y4
New Construction -�- -_� — R -eTModel / Re -Roof / Addition Home Occupation Sign
Plumbing echarrfcak�' Mobile / Manufactured Home Placement Other
Project Description /Scope of Work: �? U in it Oc cl lt_S'T K CS v:lre�_C
� q) Project Value: �.;i
Building Area (sq. ft) 1sl Floor 2r1d Floor 3r� 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?
/f yes, a completed environmental checklist must accompany permit application.
BIJILDING'OWIE NAME
ADDRESS ((` 0 5 t-) EMAIL
CITY I STATE ZIP TELEPHONE
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 CONTRACTOR f11r'i TELEPHONE
ADDRESS 0,q , EMAIL
CITY 0 W Y1 t'I STATE ZIP ^J'�r FAX !
CON TRACT�R'S'LICENSE # ( ri rWQ -EXP DATEH! s ITY LICENSE #.
Copy of mitigation agreement with Yelm Community Schools, if applicable.
1 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 withlM> laws, rules and regulations of the State of Washington and the
City of Ye lm.
/ � a
App ical nt's Signa`fiure `�° Date
Owner I 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 f riod of 180 days
Ig
AUG o O 2017
105 Yelm Avenue West B Y .. (360) 458 -3835
Yelm, 9?4 98537 4.FAX
www.ci.yelm.wa.us w "..