07-0009 Permit file 011007~ of Tt~~p~~ City of Yelm
c~'
Contractor Information:
~ ~ Community Development Department
a Fe
Building Division
Phone: (360) 458-8407
YELM Fax: (360) 458-3144
Applicant:
Name: L 8 G Construction
Address: 10231 Kiwa Drive SE City: Olympia
Property Information:
Site Address: 301 1st Street
Assessor Parcel No. Subdivision:
Permit rvo: BLD-07-0009-YL
Issue Date: 01/10/2007
(Wo rk must be started within 180 days)
Receipt No: 45385
Phone: 360-438-1015
State: WA Zip 98513
Lot:
Name: Applicant Contact:
Address: City:
Contractor License No: Expires:
Project Information:
Project: 301 1st Street Re-roof
Description of Work: Re-roof Bld K, O & R
Sq. Ft. perfloor: (1st) 0 (2nd) 0 (3rd) 0 Garage 0
Heat Type (Electric, Gas, Other):
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate
Building Permit -Other 111.25 0.00 0.00 0.0000
TOTAL FEES: $111.25
Applicant's Affadavit
Phone:
State: Zip:
Business License:
Basement 0
No. Units Unit Desc
0.0000 $1,000
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 futher certify that I am currently
registered in the State of ashington. ,~
Signature ~~~ Date
-- -~- /~~'-~~G.
Firm
s of Prints:
Inspection:
By:
RECEIVED
CITY OF
YELM
P,(1 box d14,
Yelni, WA 94591
360 458 8ap3
RECEIPT No. 4 5 3 $ 5
RECEIVED FROM DATE REC. NO. AMOUNT RCf NO
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
-~ ~ 7 ^ ~ Parcel #: ~ y//~ `~ ~~ ~ ~ y
Project Address: -SD 1 ~S S ~ ~`
Zoning; Current Use: (NI. i vt ~ 5 ~"aa c,~roposed Use: S ck m ~-'
U New Construction ~Re-Model / Re-Roof /Tenant Improvement
u Plumbing u Mechanical u Fire Prevent/Suppress/Alarm u Other
~ ~
Project DescriptioNScope of Work: t` e ~ c o ~ ~~~ ~ ~ ~ l~~i ~ ~ ~ L-C ~3 .
Project Value: ~ Z o ~ . --
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.
BUILDING OWNERlTENANT NAME:
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
MECHANICAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Copy of Clty Mklgatlon documentation (TFC).
I hereby certtfy that the above fnformatlon Is correct and that the construction on, and the occupancy and the use of the
above described property will be In accordance wkh the laws, rules and regulations of the State of Washington and the
City o1 Yelm.
~ `:~ ~~
--~ ~- ~
~=-~
A cant's Signature ate
ner /Contractor /Owner's Agent /Contractor's Agent /Tenant (Please circle one.)
All permits are non-transferable and will expire if work authorised 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 AuenueWeat
PO Bor 479
Yelm, WA 98597
(360) 458-3835
(360) 458-3144 FAX
u+eum.ci.yelm.wa. us
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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 LGCON'"990JR
Licensee Name L ft G CONSTRUCTION
Licensee Type CONSTRUCTION CONTRACTOR
UBI 278051130 Verify Workers Comp Premium
Status
Ind.lns. Accoundt 28646302
Business Type INDIVIDUAL
Address 1 10231 KIWA DRIVE SE
Address 2
City OLYMPIA
County THURSTON
State WA
Zip 98513
Phone 3604381015
Status ACTIVE
Specialty 1 ROOFING
Specialty 2 CARPENTRY/FRAMING
Effective Date 4/19/2001
Expiration Date 5/12/2007
Suspend Date
Separation Date
Parent Company
Previous License
Next License
Associated
License
Business Owner Information
Name Role Effective Date Expiration Date
GORDON, MARY OWNER 01/01/1980
Bond Information
Bond Bond
Company
Name Bond
Account
Number
Effective
Date
Expiration
Date
Cancel
Date
Impaired
Date
Bond
Amount
Received
Date
https://fortress.wa.gov/lni/bbip/Detai I.aspx'?License=LGCON* *990JR 1 /10/2007
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TRAVELERS
CAS 8 Until
#5 SURETY 103490901 04/12/2005 Cancelled $6,000.00 03/03/2005
ACCREDITED
SUR li CAS Until
#4 COINC 10016619 04/12/2004 Cancelled 04/29/2005 $6,000.00 03/25/2005
GULF INS Until
#3 CO 634220942 04/25/2003 Cancelled 04/27/2004 $6,000.00 04/22/2003
GULF INS Until
#2 CO 6324220942 04/12/2002 Cancelled 01/31/2005 $12,000.00 04/25/2002
GRANITE
STATE INS Until
#1 CO 256984 04/12/2001 Cancelled 04/16/2002 $600.00 04/19/2001
Savings Information
No Matching Information
Insurance Information
Company Policy Effective Expiration Cancel Impaired Received
Insurance Name Number Date Date Date Date Amount Date
FIRST
MERCURY
#7 INS CO FML002055 10/27/2006 10/27/2007 $300,000.00 10/30/2006
ATLANTIC
CAS INS
#6 CO L0880002963 10/21/2005 10/21/2006 $300,000.00 10/21/2005
ATLANTIC
CAS INS
#5 CO L0880002962 10/21/2004 10/21/2005 $300,000.00 10/12/2004
ATLANTIC
CAS INS
#4 CO L088000296 10/21/2003 10/21/2004 $300,000.00 10/27/2003
ATLANTIC
CAS INS
#3 CO L088000296 10/21/2002 10/21/2003 $300,000.00 11/12/2002
WESTERN
HERITAGE
#2 INS CO SCP0422512 04/13/2002 04/13/2003 10/29/2002 $300,000.00 04/25/2002
WESTERN
NATIONAL
#1 ASSUR CO SCP0386756 04/13/2001 04/13/2002 04/19/2001
Summons /Complaints Information
No Matching Information
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https://fortress.wa.gov/lni/bbip/Detail.aspx?License=LGCON* *990JR 1 /10/2007