07-0001Permit Pkg 010207'~ pf TH~pR ~ City of Yelm
~~ 9~ Community Development Department
Building Division
Phone: (360) 458-8407
YELM Fax: (360) 458-3144
Applicant:
Name: Chick, Norma
Address. City:
Property Information:
Site Address: 10732 Tucannen Ct.
Assessor Parcel No.
Contractor Information:
Name: Puget Sound Gas
Address: 4516 128th St. E
Contractor License No: PUGETSG956MA
Subdivision:
Contact:
City: Tacoma
Expires: 07/01 /07182
Project: Norma Chick
Description of Work: Gas Piping for new generater
Permit Ivo: M-07-0001-YL
Issue Date: 01/02/2007
(Work must be started within 180 days)
Receipt No: 45125
Phone:
State: Zip
Lot:
Phone. 1-888-661-7283
State'. WA Zip: 98446
Business License:
Sq. Ft. per floor: (1st) 0 (2nd) 0 (3rd) 0 Garage 0 Basement 0
Heat Type (Electric, Gas, Other):
Fees:
Item Item Fee Base Amt Unit Fee
-----------
-- Unit Rate
----------- No. Units Unit Desc
------------------------
Mechanical Permit -----------
25.00 -------
0.00 0.00 0.0000 0.0000
TOTAL FEES: 525.00
Applicant's Affadavit:
OFFICIAL USE ONLY
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 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 Washington. Final Inspection:
C. ~ ~ ~ .~ J ~ ~ I Date
Signature Date A/ ~Q
By: --
Finn
`~ p`\ ___ __ ..____ .__... ... _____.____. ..._.... _ ..
"~, ~ "" ; ~ CITY OF
~,~ = YELM
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rslin, WA 9P,~i4;
YELM 36f1-058-$hQ3
RECEIVED a , _ _.
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RECEIVED FRi~M DATE. RLG NU.
i~
l I~ZAP;=~
RECEIPT No. QJ 12 5
AMOl1NT REF. Nq.
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General/Specialty Contractor
A business registered as a construction contractor with L81 [o 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 PUGETSG956MA
Licensee Name PUGET SOUND GAS PIPING INC
Licensee Type CONSTRUCTION CONTRACTOR
UBI 602435577 Verify Workers Comp Premium
Status
Ind. Ins. Account
Id
Business Type CORPORATION
Address 1 4516 128TH ST E
Address 2
City TACOMA
County PIERCE
State WA
Zip 98446
Phone 2535394488
Status ACTIVE
Specialty 1 PLUMBING
Specialty 2 OTHER (SPECIFY)
Effective Date 7/1/2005
Expiration Date 7/1/2007
Suspend Date
Separation Date
Parent Company
Previous License
Next License
Associated
License
Business Owner Information
Effective Expiration
Name Role Date Date
BRADLEY,
ANTHONY PRESIDENT 07/01/2005
BISCARRET,
DOMINIC SECRETARY 07/01/2005
VICE
ANDERSON, ANDY PRESIDENT 07/01/2005
https://fortress.wa.gov/lni/bbip/Detail.aspx?License=PUGETSG956MA 1/2/2007
Look Up a Contractor, Electrician or Plumber License Detail Page 2 of 2
Bond Information
Bond Bond
Company Account Effective Expiration Cancel Impaired Bond Received
Bond Name Number Date Date Date Date Amount Date
CAPITOL
INDEMNITY Until
#2 CORPORATION 919233 03/02/2006 Cancelled 56,000.00 03/08/2006
ACCREDITED
SURETY & CAS Until
#1 CO 10034091 02/11/2005 Cancelled 02/11/2006 56,000.00 07/01/2005
Savings Information
No Matching Information
Insurance Information
Company Policy Effective Expiration Cancel Impaired Received
Insurance Name Number Date Date Date Date Amount Date
LINCOLN
#4 GENREAL PUGET7 12/06/2006 12/06/2007 51,000,000.00 12/06/2006
SCOTTSDALE
#3 INS CO CLS226097 06/06/2006 06/06/2007 12/03/2006 5300,000.00 06/07/2006
NORTHFIELD
#2 INS CO CP489188 03/02/2006 03/02/2007 05/24/2006 5300,000.00 03/08/2006
NORTHFIELD
#1 INS CO CP453668 02/11/2005 02/11/2006 5300,000.00 07/01/2005
Summons /Complaints Information
No Matching Information
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https://fortress.wa.gov/lni/bbip/Detail.aspx'?License=PUGETSG956MA 1 /2/2007
a
.~~~~~~~ ~~Z 0.7
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: ~ ~ ~ ~ ~ "t lti ~ ~~ n 0 ~t ~f .S - t=Parcel #: ~ •' , ~ ~~ nc~ ~-t/L~
Subdivision:-utilrn~ ~,'1-_ Lot#: ~4 Zoning;
New Construction Re-Model / Re-Roof /Addition Home Occupation Sign
Plumbing Mechanical Mobile /Manufactured Home Placement Other
Project Description/Scope
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.
BUILDING O ER NAME:
ADDRESS b -f m G C h l, l~ EMAIL
CITY~;.t=l [art TATEy,~~_ZIP~TELEPHONE ~pc2=y
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 CONTRACTOR - «e~r Sa u rr~ G'i+S TELEPHONE (- ~~S (~ /e / -r1,>`Lp j
ADDRESS -. ~~~~ EMAIL
CITY STATE ZIP FAX
C;C?N T RACTOR'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
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 }P1171 Ai'PIIUC {3'6sl (360) 458-3835
PO 13o.r 479 (360) 458-3144 FA.I'
~'elrn, {iA 98597 wu~u!.ci.velm.u~n.us