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20180215 303 Washington Ave SW Mech wrIr-of THeiri City of Yelm Permit No.: 20180215 Community Development Department Fee Calculation Worksheet Building Division Phone: (360)458-8407 Fax:(360)458-3144 Applicant: Name: JEROME L BALDWIN Phone: 360-458-8671 Address: P.O. BOX 1693 YELM WA 98597 Property Information: Site Address: 303 WASHINGTON AVE SW Owner: JEROME L BALDWIN Assessor Parcel No.: 75300800600 Subdivision: Lot: Project Information: Project: MECHANICAL Description of Work: REPLACE GAS FURNACE AND ADD A/C Sq. Ft. per floor: First Heat Type(Electric, Gas, Other): Second Third Garage Basement Fees: Item Units Fees MECHANICAL PERMIT 1 $ 20.00 WHOLE HOUSE FAN/MISCELLANEOUS 1 $ 9.50 TOTAL FEES: $ 29.50 PAYMENTS MADE: $ 0.00 BALANCE DUE: $ 29.50 CITY OF YELM RESIDENTIAL BUILDING PERMIT APPLICATION FORM Project Address: : • A . a.iu s cSt) Parcel #:—7 ,t)08 WLEC3O Subdivision Lot #: Plan #: Zoning: New Construction Re-Model I Re-Roof/Addition Home Occupation Sign - Plumbing Mechanical E Mobile/Manufactured Home Placement Other Project Description/Scope of Work:')2t1ttCeP €Xi StinC CTC.-Pa rrei r° CIr 1> II /07 Ton TornP Project Value: S L95 . Building Area (sq. ft) 151 Floor 2r° Floor Garage Deck Basement Carport Patio # Bedrooms # Bathrooms_ Heating GAS/OTHER or ELECTRIC (Circle One) Are there any environmentally sensitive areas located on the parcel? If yes, a completed environmental checklist must accompany permit application BUILDING OWNER NAME: Lir7 ADDRESS 3t .? dine tr ' f\—NIS c-,1A1-1 EMAIL CITY Y-clm STATE %Aire ZIP 94,r—F1 TELEPHONE ?L4‘) �1`it �e 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 CONTRACTORervnfl r� 1-irrIti TELEPHONE • 46 '19 CO. ADDRESS LiJt • I B-71-1 1 i EMAIL ,\currtre t_,,79Yornr-A-i i' t •C©>77 CITY G.) -t STATE inti, ZIP c 3 iv FAX ,� 101 ; CONTRACTOR'S LICENSE #��r.jiW �iR" XP DATE1119Gt TY LICENSE # Copy of mitigation agreement with YeIm 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 bo in accordance with the laws,rules and regulations of the State of Washington and tho City of Yelm. 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 period of 180 days 105 Yelrn Avenue West (360) 458-3835 Yelrrt, WA 98597 (360) 458-3144 FAX wiaw.ci.yelrn.toa.us Citi of Yell (35 ).458-3244 REC#1 00309000 6/08/2018 9:03 AM OPER: ASHCO TERM: 007 REF#: 48589 PAID BY: TRAM: 33.0000 BUILDING PERMITS 20180215 29.50CR BALDWIN, JEROME L 303 WASHINGTON AVE S MECH 0CR TENDERED: 29.50 CHECK. APPLIED: 29.50- CHANGE: 0.00 tal a Q sit 0