07-0022 Permit Pkg 013107~oF Tip City of Yelm
v
Property Information:
Site Address: 10501 Creek St. SE
Community Development Department
Building Division
Phone: (360) 458-8407
YE Fax: (360) 458-3144
Applicant:
Name: Blenderz
Address: 17926 158th Ave. SE City: Yelm
Assessor Parcel No. 69280000700 Subdivision
Contractor Information
Name: The Plumber Contact:
Address: 540 Valentine Ave. SE City: Pacific
Contractor License No: PLUMB••196JZ Expires: 04/09/08100
Project Information:
Project: Blender=
Description of Work: Install 3 fixtures and studor vents
Sq. Ft. perfloor: (1st) 0 (2nd) 0 (3rd) 0
Heat Type (Electric, Gas, Other): OTHER
Permit No: PL-07-0022-YL
Issue Date: Ned / - ~ % -L, 7
(Work must be started within 180 days)
Receipt No: 45991
Phone: 481-1330
State: WA Zip 98597
Lot:
Phone: 253-297-6503
State: WA Zip: 98047
Business License:
Garage 0 Basement 0
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate
Plumbing Permit 41.00 20.00 _ 21.00 7.0000
TOTAL FEES: x41.00
Applicant's Affadavit
No. Units Unit Desc
3.0000 Fixture _
OFFICIAL USE ONLY
l Sets of Prints:
inal Inspection:
Date:
By:
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
regist red in the State of Washington.
n ~
`~ ~ / _ 1
Signa re ~ ~ ~ ~ j/,J Date C,~ l ~I ~~
Firm
P.O. eox 479
Yelm, WA 98597
360-458-8403
RECEIVED
RECEIVED FROM
BLENDERZ
CRT 45991
PLUMBING PERMIT
*****NEGATIVE AMOUNT***
DATE REC. NO.
02/01/06 45992
BUDGETARY
RECT ERROR SHOULD BE 2007
CITY OF
YELM
P.0. Box 479
Yelm, WA 98597
360-458-8403
RECEIVED
~A~I I#E-
****FORTY ONE DOLLARS & 00 CENTS
RE`;f-INFO FROM DATE REC. NO.
BLENDERZ 02/01/07 45997
17926 158TH AVE SE
YELM WA 98597 BUDGETARY
3PrN3i~& --- -
PLUMBING PERMIT
RECEIPT No. 4 5 9 9 2
AMOUNT REF. NO
41.00-CHECK CRT4599
RECEIPT No. 4 5 9 9 7
AMOUNT REf= NO.
41.00 CHECK 1124
- ~.
x ,,,„~, s,
, _-
CITY - - -
or
,,
r ~
a YELM
/
/
/
<
C
\ F~~~ r~,,, ,,~,
~ Yelm W~ '1R~97
YEL ^~D q53-ft4U3
****FORTY ONE DOLLARS & 00 CENTS
BLENDERZ /
~10~7Le6~ 4 5 9 91
17926 158TH AVE SE
YELM, WA 98597 BUDGETARY
RECEIPT ~o. 4 5 9 91
nert,ur" itFi ~~)r,
41.00 CHECK 1124
DIRNA
PLr4B FRP1T
(!a ~~/
~ ~~ Z1~
Z~b~ Zvi ~
~~L-~a+~r1-
'2
gyp
Q~~w
~ 1 ~~ ~
~~,~~1~
~ ~ ,~ , ~~~
-~~,f ~ ''J ~~
~` y~ ~'
g /f~
i
noa
~~
~,
'? 1
~~
~~
~~ ~ ~,~r
~y~ ~~l - I
a'~'~s ~r``~~ "
~w~5 ~~2 -I
0
N
Q:
Z
a
~~t ~~~~~
~lx ~
t
~n
~. a -~
~ _---- ~
~n
S~ ~l"'` ~',~3~ ~ ,7 ~Z
~ ~~r~5~ ~+~~ ~
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address:_l ~ rj O ~ ~ P~ ~ ~~ Parcel #: `, `i ~ l~'c a ~ ) ~~ c
Subdivision: Lot #: Zoning,
. New Construction Re-Model / Re-Roof / Addftion Home Occupation Sign
rPlum,bing__:~ Mechanical -Mobile /Manufactured Home Placement Other
Project DescriptionlScope of Work:~G~ -~- ~~ 5~L D~ ~ - 2 ~~~ ~ ~?~i~ ~ _ f~/A ~i~K
Project Value: f - !~G Mf n
Building Area (sq. ft) 1s1 Floor 2nd 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 es, a
completed environmental checklist must accom an y
p y permit application.
GENERAL
CITY
CITY
Copy of mitigation agreement with Yelm Community Schools, if applicable.
rtify that the above information is correct and that the construction on, and the occupancy and the use of the
{ibed property will b~,i~ccordance with the laws, rules and regulations of the State of Washington and the
n. / /
Applica ig re
Date
Owner ontractor /Owner's Agent /Contractor's Agent (Please circle one.)
All perm) are non-transferable and will expire if work authorized by such permit is not begun ~ r,'-
within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days ` `'' ~' "'~
JAN 2 9 2GG1
105 Yelm Avenue West (360) 458-3835
PO Bor 479
)'elm, 4{'A 98597 (360) 458-3144 FAX
roww.ci.yelm.wrr.us
Look Up a Contractor, Electrician or Plumber License Detail Page 1 oft
`l .. ~I
Topic Index ~ Contact Info Search
Home Safety Claims >~ Insurance ~ Workplace Rights Trades l3 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 PLUMB'•961JZ
Licensee Name THE PLUMBER
Licensee Type CONSTRUCTION CONTRACTOR
UBI 602385130 Verify Workers Comp Premium
Status
Ind. Ins. Account
Id
Business Type INDIVIDUAL
Address 1 540 VALENTINE AVE SE
Address 2
City PACIFIC
County KING
State WA
Zip 98047
Phone 2532976503
Status ACTIVE
Specialty 1 PLUMBING
Specialty 2 UNUSED
Effective Date 4/9/2004
Expiration Date 4/9/2008
Suspend Date
Separation Date
Parent Company
Previous License
Next License
Associated
License
Business Owner Information
Name Role Effective Date Expiration Date
CANNON, HARRY W JR OWNER 04/09/2004
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/Ini/bbip/Detai I.aspx?License=PLUMB* *961,17 1 /31 /?007
Look Up a Contractor, Electrician or Plumber License Detail Page 2 of 2
AMERICAN
STATES INS Until
#2 CO 6335169 04/08/2005 Cancelled $6,000.00 03/02/2005
ACCREDITED
SUR 8 CAS Until
#1 COINC 10016522 04/08/2004 Cancelled 04/29/2005 $6,000.00 04/09/2004
Savings Information
No Matching Information
Insurance Information
Company Policy Effective Expiration Cancel Impaired Received
Insurance Name Number Date Date Date Date Amount Date
FIRST
NATIONAL
INSURANCE
#3 COMPA 01CG54644520 04/08/2006 04/08/2007 $300,000.00 03/15/2006
FIRST
NATIONAL
INSURANCE
#2 COMPA 01CG54644510 04/08/2005 04/08/2006 $300,000.00 03/02/2005
AMERICAN
STATES INS
#1 CO 01CE290145 04/08/2004 04/08/2005 $300,000.00 04/09/2004
Summons /Complaints Information
No Matching Information
Start a New Search Printer Friendly Version
'~ About L&I ~ Find a job at U31 ~ Information en espatiol ~ Site Feedback ~ 1-800-547-8367 ' _'
,~ 4vashingtnn Slate Dent, of LahFir and Industries. Use of this site is subiect. tp the laws of the state of Washington. C~, ~~~~~~~~
~1~J ncccss n¢r<~e~nrnt ~ Prtvacv anU security statement ~ Intended use/external crNrtent pohcv I Staff only tink vui:.,,-.-r;;,v;a,s;,,,:
https://fortress.wa.gov/lni/bbip/Detail.aspx?License=PLUMB * * 961 JZ 1 /31 /2007