07-0101 Permit Pkg 031607 ~OF TFlFP~
~ City of Yelm
'
`4
Community Development Department
Building Division
Phone: (360) 458-8407
EL Fax: (360) 458-3144
A
li
pp
cant:
Name: Conley
Address: 109 Van Trump Ave. NE City: Yelm
Property Information:
Site Address: 109 Van Trump St. NE
Assessor Parcel No. Subdivision:
Contractor Information:
Name: Outhouse Plumbing Contact: Crossland, Bob
Address: P.O. Box 2394 City: Yelm
Contractor License No: OUTHOP'990BP Expires: 04/14/08105
Project Information:
Project: Conley Bed and Breakfast
Description of Work: Add two bathrooms with 3 fixtures each
Sq. Ft. per floor: (1st) 0 (2nd) 0 (3rd)
Heat Type (Electric, Gas, Other):
Fees
Permit No: PL-07-0101-YL
Issue Date: Not Issued
(Work must be started within 180 days)
Receipt No: 47703
Phone: 400-1327
State: WA Zip 98597
Lot:
Phone: 458-8607
State: WA Zip: 98597
Business License:
Garage 0
Item- _ ~ Item Fee Base Amt Unit Fee Unit Rate
Plumbing Permit 62.00 20.00 42.00 7.0000
TOTAL FEES: 162.00
Applicant's Affadavit:
Basement 0
No. Units Unit Desc
6.0000 Fixture
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,
easem8nts ana restrictions of record. I);ap~lyi~~ a contractor, I futher certify that I am currently
fP.n IC}PfPf} in the .Ct~fo of 1A/.,n l,:....~../~~'"
Signature'/ / ~ G'L
~~-- Date
Firm
=FILIAL USE -ONLY
s of Prints:
Inspection:
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.:, ~-~ YELi~9
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~ ~,..~„• ,,: ~,; RECEIPT ~~':
~YL•L.yt ~. fir; q.,~~i ~,
k*''*SIXTY TWO DOLLARS & 00 CENTS
CONLEY 03/16/07 47703 62.06 CIIECK 3732
109 VAN TRU1{P ST NE
YEL11 WA BUDGETARY
3G9-40a-1327
FIICHELLE
FI,UIfB]N~:~ FERPITT Fi..-0i-N 10]-YL,
• We are installing two bathrooms facilities within two of the existing bedrooms on the second floor of our
home.
• We are located at 109 Van Frump Ave NE Yelm, WA 98597
• These bathrooms are within our current residence. Although we do run Conley Suites Bed & Breakfast, nei-
ther bathroom at this time is for use by our guests. They are just in addition to residential space at this time.
• All work will be done within the current structure
~.c'll~~~t.t
~ 'F_' `~"
Tub 60" x 0" x Tub 0' x 36" x 20"
~~"
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---~ l1
`~ ~ Room I ~ ~ ~r~, Y~ -~ ~~
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Second Floor that is over the gazage ~ `~ ` C~ ` t ~
~~
5
Look Up a Contractor, Electrician or Plumber License Detail Page 1 of 2
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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 OUTHOP'990BP
Licensee Name OUTHOUSE PLUMBING
Licensee Type CONSTRUCTION CONTRACTOR
UBI 601275429 Verify Workers Comp Premium
Status
Ind. Ins. Account
Id
Business Type INDIVIDUAL
Address 1 PO BOX 2394
Address 2
City YELM
County THURSTON
State WA
Zip 98597
Phone 3604586607
Status ACTIVE
Specialty 1 PLUMBING
Specialty 2 PLASTERING
Effective Date 1/17/2001
Expiration Date 4/14/2008
Suspend Date
Separation Date
Parent Company
Previous License
Next License
Associated
License
Business Owner Information
Name Role Effective Date Expiration Date
CROSSLAND, DELANCE D OWNER 01/17/2001
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/Detail.aspx?License=OUTHOP*990BP 3/15/2007
Look Up a Contractor, Electrician or Plumber License Detail Page 2 of 2
lt3 WESTERN
SURETY
CO
69944168
09/02/2005
Until
Cancelled
56,000.00
09/06/2005
HARTFORD
FIRE INS Until
#2 CO 01656607342 03/13/2002 Cancelled 09/23/2005 56,000.00 03/18/2002
INDEMNITY
INS CO OF Until
111 N AMERICA K05260176 03/13/2000 Cancelled 03/13/2002 54,000.00 01/17/2001
Savings Information
No Matching Information
Insurance Information
Company Policy Effective Expiration Cancel Impaired Received
Insurance Name Number Date Date Date Date Amount Date
FARMERS
INS
#5 EXCHANGE 602224818 09/02/2005 09/02/2007 5500,000.00 09/01/2006
FARMERS
INS
ft4 EXCHANGE 602224818 09/02/2004 09/02/2005 5500,000.00 03/21/2005
b3 HARTFORD 01SBAKH6950 03/13/2004 03/13/2005 5500,000.00 03/02/2004
ITT
tl2 HARTFORD 01SBAKH6950 03/13/2001 03/13/2002 03/12/2001
ITT
#1 HARTFORD TBD 03/13/2000 03/13/2001 01/17/2001
Summons /Complaints Information
No Matching Information
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https://fortress.wa.gov/lni/bbip/Detail.aspx?License=OUTHOP*990BP 3/15/2007
R~~
~'~~a
CITY OF YELM MAR j ~ 20 p~
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: (~~~ "L~-E U ~ ~~~~~ ~ ~ ~ , .; ' !,~
~~ ~ ,l / y' ~- Parcel #:
Subdivision: ~ `/~/~` 7a GC~Z~
Lot #:~ Zoning; ~ . , , Q ~ ,gyp
' New Construction ~ C~ '
Re-Model / Re-Roof /Addition '~ 1
~l Plumbing ~ Mechanical Home Occupation Sign ~~I ~(~
(\ _ Mobile /Manufactured Home Pla ement 1
Project DescriptioNScope of Work: ~ ' Other
~ .,
Project Value: ~ ~ 1 ~ (J /'Z~5
Building Area (sq. it) 1 ~` Floor__
2nd Floor=_ Garage __
Basement Deck
-~Carport~patio~
# Bedrooms_ # Bathrooms_~
Heating GAS THER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? ~~~ If
completed environmental checklist must accompany permit application.
o~ ~~~ ~..._ _. yes, a
CITY
~• •va- tr
-- opy of mitigation agreement with Yelm Community Schools, if applicable.
1 hereby certFfy that the above informatlon Fs correct and that the construction on, and the occupancy and the use of
Ctty of Yelm, the
above described property „„~~~ ~ ~n accordance with the Iavis, rules and regulations of the State of Washington and t
he
Applicant's Signature
Owner /Contractor /Owner's Agent /Contractor's Agent (Please circletone.)
All permits are non-transferable and will expire If work authorized by such permit is not b
within 180 days of Issuance, or if work is suspended or abandoned for a period of 180 da
egun
ys
PO Box 479
Yelrn, WA 98597
(360) 458-3144 FAX
u~wtn. ci.yelm. ur p, u8