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07-0003 Permit file 011207of THEp~~ City of Yelm Community Develo Building Division Phone: (360) 458-840 yEI, Fax: (360) 458-3144 pment Department 7 Applicant: Name: The Versatile House Doctor Address: 14233 Yelm Hwy SE City: Yelm Property Inforration: Site Address: 202 Cullens Assessor Parcel No. 21724141200 Subdivision: Contractor Information: Name: Applicant Contact: Address: Ciry: Contractor License No: Expires: Project Information: Project: Yelm Family Medicine Description of Work: Reroof Medical Center Sq. Ft. per floor: (1st) 0 (2nd) 0 (3rd) 0 Heat Type (Electric, Gas, Other): OTHER Permit No: BLD-07-0003-YL Issue Date: 01N2/2007 (Wo rk must be started within 180 days) Receipt No: 45419 Phone: 791 x1244 State: WA Zip 98597 Lot: Phone: State: Zip: Business License: Garage 0 Basement 0 Fees: Item Item Fee Base Amt Unit Fee Unit Rate Building Permit -Other ^377.25 0.00 0.00 0.0000 TOTAL FEES: 5377.25 No. Units Unit Desc 0.0000 $1, 000 Applicants Affadavit: OFFICIAL USE 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 # Sets of Prints: Yelm regulation including tho a governing zoning and land subdivision, and in addition, all covenants, easements and estri~on$$ of ~ecord. If applying as a contractor, I futher certify that I am currently registered in th Sfat1 of WashiPgt~n^ Final Inspection: ! `JJ r ~ / Tl d~' ~J Date: Signature ~~' W Date '~ "' ~~ '~ By: Firm City of Yelm Community Development Department Building Division Phone: (380) 458-8407 Fax: (360)458-3144 AppllcaM: Name: The Veraatlle House Doctor Address: 14233 Yelm Hwy SE Protect Information: Project: Yelm Family Medicine Description of Work: Reroof Medical Center Site Address: 202 Cullens Feea: Item Acct Code Building Permit -Other 032 001-322-10-00 TOTAL FEES: City: Yelm Permit Fees Schedule Permit No: BLD-07-0003-YL Phone: 791-4244 State: WA Zip 98597 Assessor Parcel No. 21724141200 Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc 377.25 ~ 0.00 0.00 0.0000 0.0000 31,000 3377.25 ~'~F THE '~I CITY OF - -~ ~ • YELM P.O. Box 479 Yeim, wA sass7 360-458-8403 RECEIPT No. 4 5 419 RECEIVED '' ~ "`'`THREE HUNDRED SEVE'3TY SEVEN DOLLARw ~4 25 CENTS RECEIVED FROM DATE REC. NO. ~ AMOUNT REF. NO. THE VERSATILE HOUSE DOCTOR 14233 YEL ©1/12/D7 45419 377.25 CHECK 6694 M HWY SE YELt~i WA 9859? BUDGETARY 791-4244 BUILDING PER1iIT BLD-07-~J003-YL CITY OF YELM COMMERCIAL BUILDING PERMIT APPLICATION FORM Project Address: 2 ~~ Chi l (~~c~ Parcel #: Zoning; Current Use: Proposed Use: u New Construction ~ Re-Model / Re-Roof /Tenant Improvement U Plumbing U Mechanical U Fide Prevent/Suppress/Alarm u Other Project DescriptioNScope of Work: ~1 ~~-f"~ ~ --~ Project Value:~(~~~ Building Area (sq. ft) Parking Garage 1~' Floor 2nd Floor 3rd Floor Building Height Are there any environmentally sensitive areas located on the parcel? If yes, a completed environmental checklist must accompany permit application. cITY 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 Clty Mklgatlon documentation (TFC). 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 with the laws, rules and regulations of the State of Washington and the City of Im. ~ - -D Ap is nt's ignature Date Own 1 Contractor /Owner's Agent /Contractor's Agent I Tenant (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 ~~o~,c~u 105 Yelm AuenueWeet (360) 458-3835 PO F3os 4T9 (360) 458-3144 FAX Yelm, WA 98597 u~u~w.ciyelm.u•a.ua Thurston Geodata Center -Parcel Search Data for Parcel No. 21724141200 Zoom Map to Parcel Please make sure to READ our DATA DISCI:AIMI-;IZ hri«r to utilirin~~ ~~ur ~~~hsite liar research View Assessor's Data for Parcel Owner: ELLEDGE MEDICAL BLDG LLC Address: PO BOX 760 City: YELM State: WA, 98597 Page 1 of 2 Parcel No.: 21724141200 Site Address: 202 CULLENS ST NW Site City: YELM Site Zip: 98597 Section: s24171 E Section 24 Township 17 Range 1 E Quarter SE NE DAF: COM X NELY LN JEFFERSON ST & NWLY Legal Description: LN SOLBERG'S ;THENCE N53-30-30W ALG JEFFERSON ST 450E TPOB THENCE CONT N53- 30-30WRLG ST 400E THENCE N37-56E Usecode: 65 -SRV-PROFSNAL Tax Code Area: 170 Taxable: Yes Annual Tax: $16,845.46 Property Type: SRV Total Acres: 2.07 Land Value: $325,450.00 Building Value: $867,700.00 Total Value: $1,193,150.00 Current Use: N Exemptions: None Wetlands: Unknown Floodzone: NO Flood of 1999: Unknown Winter Flooding of 1996: Unknown High Groundwater Flood Hazards: Unknown Zoning: R-6, http://geomap l .geodata.org/website/cadastral/resultsparcel.asp?parcel=21724141200 1 /5/2007 Thurston Geodata Center -Parcel Search Page 2 of 2 Historic Site: No Permitting Jurisdiction: YELM Jurisdiction of Influence: YELM Stormwater Rate: No No Shooting Zone: No Animal Control: Contact Animal Control (360-458-3244). Weed Containment Zone: No Steep Slopes: Unknown Ground Water Sensitive Areas: No DNR Natural Heritage Data: Unknown Critical Buffers: No Shoreline Management Areas: No Waterbody & Wetland Buffers: No FEMA Panel No.: 355 Wellhead Protection Area: No Area of Groundwater Concern: No Elevated Nitrates: No Soil Type: Spanaway gravelly sandy loam, 0 to 3% slopes Hydric Soil: No Watershed: NISQUALLY RIVER Water Service Area: YELM, CITY OF School District: YELM Elementary School: SOUTHWORTH Middle School: MILL POND AND YELM High School: YELM Fire Response District: YELM Medic Response District: Medic 2 Residential Outdoor Burning: Residential Outdoor Burning is banned within the city limits and urban growth areas of Lacey, Olympia, and Tumwater. Planning Region: 2 Census Tract: 012410 Radio or Cell Tower: No Airport Zone: No http://geomapl .geodata.org/website/cadastral/resultsparcel.asp`?parcel=21724141200 1 /5/2007 Look Up a Contractor, Electrician or Plumber License Detail Page I of 2 ~l ~ Topic Index ~ Contact Info Search -c ~' ' ' . ' ~ ° Home Safety ' Ctaims 8 Insurance Workplace Rights Trades 13 Licensing Find a Law or Rule Get a Form or Publication ~ Help Look Up a Contractor, Electrician or Plumber Printer Friendly Version General/Specialty Contractor A business registered as a construction contractor with L81 to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. License Information License VERSAHD947Q6 Licensee Name VERSATILE HOUSE DOCTOR, THE Licensee Type CONSTRUCTION CONTRACTOR UBI 602169074 Verify Workers Comp Premium Status Ind. Ins. Account Id Business Type INDIVIDUAL Address 1 14233 YELM HWY SE Address 2 City YELM County THURSTON State WA Zip 98597 Phone 3604585885 Status ACTIVE Specialty 1 HANDYMAN Specialty 2 UNUSED Effective Date 11 /2/2006 Expiration Date 11/2/2008 Suspend Date Separation Date Parent Company Previous License Next License Associated License Business Owner Information Effective Expiration Name Role Date Date IVERSON, Individual - VERN HandyMan 11/02/2006 Bond Information Bond Bond Company Account Effective Expiration Cancel Impaired Bond Received https://fortress.wa.gov/lni/bbip/Detail.aspx'?License=VERSAI ID947QB 1/5/2007 Look Up a Contractor, Electrician or Plumber License Detail Page 2 of 2 Bond Name Number Date Date Date Date Amount Date COLONIAL AM CAS Et SURETY Until #1 OF M LPM4072511 10/04/2006 Cancelled 56,000.00 11/02/2006 Savings Information No Matching Information Insurance Information Company Policy Effective Expiration Cancel Impaired Received Insurance Name Number Date Date Date Date Amount Date SCOTTSDALE #1 INS CO CLS1285591 10/04/2006 10/04/2007 5300,000.00 11/02/2006 Summons /Complaints Information No Matching Information Start a New Search Printer Friendly Version ~®" ~ About L&I ~ Find a job at L&I ~ Information en espanol ~ Site Feedback ~ 1-800-547-8367 ,, l__ ~~ ,,'wBShlni1i011 i gq Washinnton $tafe~ Dr-pt csf latwr and IndusUies. Use rsf ibis site is wtsiect [o the laws of [he State of Washinpto~~. `J" ~ %.CCI'S5 AQreelnenl I ~ rivaCy and SeCUfttV SlaternBnl I (mended use external content ~ollcy I Raii un ly IUSk Vsst .,ccess.wa.gov hops://fortress.wa.gov/lni/bbip/Detail.aspx?License=V ERSAHD947QB ] /5/2007