20170309 Permit Pkg 09082017of
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Applicant:
City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Name: JACKIE BELL
Address: 10428 GROVE RD SE
YELM WA 98597
Property Information:
Site Address: 10428 GROVE RD SE
Assessor Parcel No.: 64303100704
Project Information:
Project: MECHANICAL
Description of Work:
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL PERMIT
WHOLE HOUSE FAN /MISCELLANEOUS
Subdivision:
Permit No.: 20170309
Fee Calculation Worksheet
Phone: 253 - 820 -2004
Owner: TYPE CURRENT OWNER
NAME
Heat Type (Electric, Gas, Other):
Lot: D
Units Fees
1 $ 20.00
1 $ 9.50
TOTAL FEES: $ 29.50
PAYMENTS MADE: $ 0.00
BALANCE DUE: $ 29.50
CITY OF YELM
`ff� rrR��E}}S,,IDrENTIA`L/ BUILDING PERMIT APPLICATION FORM
Project Address: 42 Q) ED64 Parcel #: U q �b�( 0Z_3�
Subdivision:
Lot #: Plan #: Zoning:
20176305
New Construction Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing Mechanical Mobile / Manufactured Home Placement Other
Project Description /Scope of Work: Ye-PI a 01K wffl 1e a w n ea± PUMP
Project Value:
Building Area (sq. ft) 1" Floor 2 "d Floor 3'd Floor Garage -2 car 3 car
Covered Patio Covered Porch Patio Deck
—
# Bedrooms_ # Bathrooms_ Heating: GAS /OTHER or LECTRI ircle One)
Are there any environmentally sensitive areas located on the parcel?
If yes, a completed environmental checklist must accompany permit application.
EMAIL
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 0LG1CA I'll I l S� JQ_JTELEPHONE
ADDRESS C EMAIL
CITY l STATE W ZIP FAX
CONTRACT R'S LICENSE # RJ W(.ell EXP DATE-,--CITY LICENSE # kLk - 0000 1
Copy of mitigation agreement with Yelm Community15chdols, 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.
Appllca s Sign Date
Owner / Contrac / 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.ei.yelm.wa.us
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b/ U /�/0
(361) 458-3244
REW 00280606 17 11:13 AN
UpEP: CO TERM: 001
REW 18864
PAIL BY:
TRAM: 33.0000 BUILDING P1RNIT3
2017030 29SCR
BELL, JACKIE
10428 GROVE RD SE
ncCn 290CA
TRAW 33.0000 BUILDING P|RNIlS
20170308 290CR
EATON' DAVID
15523 704TH PL 3E
NECH
29.5(CR
lE@DERED: 59.00 [HECK
APPLIED: 59,00-
CHANGE: 0.00