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20080280 Permit Pkg 080408 (2)City of Yelm Community Development Department Building Division Phone: (360) 458-8407 Fax: (360)458-3144 Applicant: Name: 3D General Contractors Address: P.O. Box 2574 City: Yelm Property Information: Site Address: 15407 107th Loop SE Assessor Parcel No. 62310002900 Subdivision: Contractor Information: Name: Applicant Contact: Address: City: Contractor License No: Expires: Project Information: Project: Rhodes Walkway Cover Description of Work: 12x20 walkway cover Permit Ivo: BLD-08-0280-YL Issue Date: 08/04/2008 (Work must be started within 180 days) Receipt No: 55582 Phone: 360-292-3030 State: WA Zip 98597 Lot: Phone: State: Zip: Business License: Sq. Ft. perfloor: (1st) 0 (2nd) 0 (3rd) 0 Garage 0 Basement 0 Heat Type (Electric, Gas, Other): OTHER Fees: Item --------------------------- Item Fee --- Base Amt Unit Fee Unit Rate No. Units Unit Desc Building Permit -Other -------- 377.25 ----------- ----------- 0.00 0.00 ----------- 0.0000 ----------- ------------- 0.0000 $1,000 Building Plan Review 245.21 0.00 0.00 0.0000 0.0000 TOTAL FEES: $622.46 XANNED ~, ~ Applicant's Affadavit: lam' c I certify that I have read and examined the information contained within the applicati nand 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 lying as a contractor, I futher certify that I am currently registered in the Stye of Washingtoyt~ /~ Date Firm # Sets of Prints: Final Inspection: Date: ~ '~~ By: City of Yelm Permit Fees Schedule Community Development Department .., ~ Permit No: BLD-08-0280-YL Building Division Phone: (360)458-8407 ~~G ~~ ~(;Q~ ~~ Fax: (360) 458-3144 ~~~ Applicants Name: 3D General Contractors Address: P.O. Box 2574 Project Information: Project: Rhodes Walkway Cover Description of Work: 12x20 walkway cover Site Address: 15407 107th Loop SE Fees: Item -------------------------- Building Permit -Other Building Plan Review Phone: 360-292-3030 City: Yelm State: WA Zip 98597 Assessor Parcel No. 62310002900 Acct Code Item Fee Base Amt Unit Fee -------------- ----------- ---------- ---------- 032 001-322-10-00 377.25 0.00 0.00 100 001-345-83-00 245.21 0.00 0.00 TOTAL FEES: $622.46 Unit Rate No. Units Unit Desc ----------- ---------- ------------- 0.0000 0.0000 $1,000 0.0000 0.0000 {I a °F7H~p~'l~ CITY OF ______._.___~____._._._____________~_~_:_________________. 4 ~ YELM P,O. Box 479 Yelm, WA 98597 RECEIPT No. 5 5 5 8 2 I'~ 360-458-3244 RECEIVED '~,:~~SIX H~sNi~REU T;~Istimv `t't^3(? :~~.~LLAR; & 46 '"ENTS RECEIVED FROM DATE REC. N0. AMOUNT REF. NO. LARRY RHODES S8/~410$ 55582 3D GENEP.AL CONTRACTORS 6 2.46 CHEt"~ 6 ~a~ 1 154Ci7 107TH LP SE BUDGETARY YELI-I y ~~A ~85~7 BLD-X38-~328S-YL T CITY OF YELM RESIDENTIAL BUILDING PERMIT APPLICATION FORM Project Address:lj_,~7 /~?7~ ®p ~ Parcet #: I~~ ~~ ~ ~)~~ ~ ~ C7 Subdivision: Lot #: `Z~'1 Zoning; ^ New Construction ^ Re-Model / Re-Roof /Addition ^ Home Occupation Sign ^ Plumbing ^ Mechanical ^ Mobile /Manufactured Home Placement ^ Other Project Description/Scope of Work: r~ (1( `~ ~ ~~ ~,~- ," (~ X Project Value: ~~~`~ Building Area (sq. ft) 1S` Floor 2"d 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. BUjLDING OWNER NAME: ADDRESS EMAIL CITY STATE ZIP TELEPHONE ARCHITECT/ENGINEER LICENSE # ADDRESS EMAIL CITY STATE ZIP TELEPHONE GENERAL C~ONTRACTOR ~ C ~Pn~CI~ TELEPHONE_3Co~~Z9Z-30~"''f ADDRESS /~O I~CN e?~~ EMAIL CITY~PI wl STATE~ZIP~F,gX - - ~ CONTRACTOR'S LICENSE # DATE CITY LICENSE # PLUMBING CONTRACTOR TELEPHONE ADDRESS EMAIL _ CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE # MECHANICAL CONTRACTOR TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE # 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 ! ~~ Date (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 aooz t 1nr oa 0 0 N J 105 Yelm Avenue West p a n i a a (360) 458-3835 PO Box 479 (360) 458-3144 FAX Yelm, WA 98597 ~ www.ci.yelm.wa.us Owner /Contractor /Owner's Agent /Contractor's Agent ;` ', .'~ ,. ~,_.,3 ~, ~' „,~ ~~; .~ ~ ' -~ " , i 4;.. ,ry ~~_ F ;~~ ~' _ _ ,~w; { _._ .~ ', _ . r N . ~ ~ ._~ _ ., ~ (~ ~ >e -~ ~ F ~ U ~~ ~ N 1 ,~ i~ ~ " N ~` ; _~_ _ ~ ~ ~ ~ '- ~ ~ . ~ ~ N r. . .~ ..:m.~..~.~._.r,_,._..,. -__- ' m L °_-~__~...~.. --- : U ~ w_.._.w,,.~. _ ._ - ~ ..~, ~ w ,:-_ ~,,,,«.,.,<....~. . - - 1 . i i ~ ,., "'1 ` ~ .`-,,,,,.,r ~. .. ~~~~~ _.~ __ _ ~ _ u1~:- .. 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SU~lSET AGEPJC`~ F'AGE 61 / 63 l--gent x For Review d P1eage Comment please Re • . , ~ PAY d Please 1Zecycle • • F~ea~se End arfllached • "~~~ certrfica~te of insurance. The original will fellow in the mail. ff you have any questions: Please let me know. Thank you, -' ~ ~~, -. K~ r~ ~ D ~ ~Y~' es: 3J G~ ~ Attn: A CORD, CERTIFICATE O F LIABILITY INSURANCE DATE (MM/DD/YYYY) PRODUCER 07/29/2008 (360) 357-3353 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Sunset Insurance Agency LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1429 West Bay Drive NW ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. O1 is WA 98502- INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:Oh10 Casualt Ins Com an Denise Luckenbach - 3 D General Contractors INSURER B: P.O. BOX 2574 INSURER C: INSURER D: Yelm WA 98597- INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS nF CI IrN oni iri~c ArrRFC:GTF I I~AITC Curunini ~~nv unvc o INSR ADD'L POLICY EF LTR A INSRD TYPE OF INSURANCE GENERAL LIABILITY POLICY NUMBER FECTIVE DATE MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMI TS X BRO 53753618 07/29/2008 07/29/2009 EACH OCCURRENCE S 1,000,00( COMMERCIAL GENERAL LIABILITY X DAMAGE TO RENTED PREMISES Ea occurrence 10 0 0 0 S ~ CLAIMS MADE OCCUR / / / / MED EXP An one person S 10 , 0 0 PERSONAL&ADVINJURY S 1,000,00( / / / / GE N' GENERAL AGGREGATE S 2.000, 00( L AGGREGATE LIMIT APPLIES PER: E O PRODUCTS -COMP/OP AGG S 2 , 0 0 0 , 0 0 POLICY X J C T LOC / / / / 86LIA AU TOMOBILE LIABILITY ANY AUTO / / / / COMBINED SINGLE LIMIT (Ea accident) S ALL OWNED AUTOS SCHEDULED AUTOS / / / / BODILY INJURY (Per person) S HIRED AUTOS NON-OWNED AUTOS / / / / BODILY INJURY (Per accident) S / / / / PROPERTY DAMAGE (Per accident) S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO / / / / OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE S OCCUR ~ CLAIMS MADE AGGREGATE g S DEDUCTIBLE / / / / S RETENTION $ S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY / / / / WC STATU- OTH- TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERlMEMBER EXCLUDED? E.L. EACH ACCIDENT S If yes, describe under / / / / E.L. DISEASE - EA EMPLOYEE S 1FCr: SPECIAL PROVISIONS below OTHER =~gC RIDTinn1 nc noCO nr~nuc~n n BRO 53753618 07/29/2008 / / / / 07/29/2009 / / / / E.L. DISEASE -POLICY LIMIT S 5, 00( -------------~--~°----•----~---•~••~.+.~.~c... o, cnvvrtacmcn i/JrcVIAL YKWIJIONS CERTIFICATE HOLDE ( ) - ACORD 25 (2001/08) ~,~ INS025 (otos).os Gary Carlson City of Yem P.O. Box 479 Yelm CANCELLATION ( ) - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO D O SHALL IMPOS NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS E R PR ENTATIVES. AUTHORIZED E ESE ~ WA 98597- © ACORD CORPORATION 198 ELECTRONIC LASER FORMS, INC. - (800)327-0545 Page 1 of IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) ~~ INS025 (0108).05 Page 2 of 2