07-0237 Permit Pkg 062007City of Yelm
Community Development Department
Building Division
Phone: (360)458-8407
Fax: (360) 458-3144
Applicant:
Name: Preimier Heating and Air
Address: 3520 Military Rd. E
Property Information:
Site Address: 14810 89th Ave. SE
Assessor Parcel No. 37830000500
Contractor Information:
Name:
Address:
Contractor License No:
Project Information:
Project: Leibi Heat Pump
Description of Work: Heat Pump
Sq. Ft. per floor: (1st) 0 (2nd) 0
Heat Type (Electric, Gas, Other):
City: Tacoma
Subdivision: Burnett Estates
Permit No: M-07-0237-YL
Issue Date: 06/20/2007
(Work must be started within 180 days)
Receipt No: 48984
Phone: 253-536-3357
State: WA Zip 98446
Lot: 5
Contact:
City:
Expires:
(3rd) 0 Garage 0
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate
Mechanical Permit - 29.50 0.00 Yv0.00 0.0000
TOTAL FEES: 529.50
Applicant's Affadavit
Phone:
State: Zip:
Business License:
Basement 0
No. Units Unit Desc
0.0000
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:
Signature
D ~
~~ Date D
Date
Firm By' -
RECEIVCD
CITY OF
YELM
ro Elt,r ar~~
Yr~lm W.49d597
nnf l-~ ,a J21d
~ • 1 ~ `'
REGEfVEC~ f R(7M DATE
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'A~ j~
7:~ ....
RECEIPT No. '= ~~ ~.': ~ ~+
REC,N~). AMOiIi•Il
REF, I~~_~.
Received
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM ~11N 1 1 2007
I ~o ~~~~. 3 ~s~30oocSo
Project Address: C "[ O I O ~ A b e S~ Parcel #:
Subdivision: ~~12ne ~ ~-S~a~~ Lot #: Zoning;
i New Construction i Re-Model / Re-Roof /Addition i Home Occupation Sign
i Plumbing ~4Nechanical ~ ~~ Mobile /Manufactured Home Placement i Other
Project Description/Scope of Work: 3 n ,`~~~ ~ ~ ~ '~~ ~~ ~ +~ -~
(~ :J
Project Value: ~~CX~
Q} ~\
o
Building Area (sq. ft) 1 ~' Floor 2nd Floor I'1 `~~~ Garage Deck > _
N
~
Basement Carport Patio Q~ ,_..,
GAS/ HER or ELECTRIC (Circle One)
# Bedrooms # Bathrooms aZ Heatin V ~
. Q~ --
Are there any environmentally sensitive areas located on the parcel? If yes, a ~
completed environmental checklist must accompany permit application.
ARCHITECT/ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR Porn ;ems r1ea+~n +A~TELEPHONE ~ 5 3 S 3~0 - 3 3 S`1
ADDRESS 3~~:~~` ;nl 1~-ta2 (L;l - EMAIL ~~+~~rrr~~r2 t~<<~ C fl~~ •cc`^'~
CITY -~! ~ c: ~'YL ~: STATE tti% ~ Ig~(~{ (~^ FAX <~ S 3 - J ~- S - ~ `'I rl 3
CONTRACTOR'S LICENSE #PfEmI'HAgsOmU EXP DATE' CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby certify that the above infomtatbn is correct and that the construction on, and the occupancy and the use of the
above described property will be in accordance with the lawa, rules and regulations of the State of Washington and the
City of Yelm.
~~ ~ ~
Applicant's Signature Date
Owne~ 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 Yelm Avenue West (360) 468-383b
PO Box 479 (360) 458-3144 FAX
Yelm, WA 98597 u~toto.ci.yelm.ma.ua
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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.
Information
License PREMIHA950MG
Licensee Name PREMIER HEATING 8 AIR
Licensee Type CONSTRUCTION CONTRACTOR
UBI 602188259 Verify Workers Comp Premium
Status
Ind. Ins. Account
Id
Business Type INDIVIDUAL
Address 1 PO BOX 44815
Address 2
City TACOMA
County PIERCE
State WA
Zip 98444
Phone 2532413086
Status ACTIVE
Specialty 1 AIR CONDITIONING
Specialty 2 AIR HEAT,VENTILATION,EVAPORAT
Effective Date 7/7/2005
Expiration Date 7/7/2007
Suspend Date
Separation Date
Parent Company
Previous License
Next License
Associated
License
Business Owner Information
Name Role Effective Date Expiration Date
WAUN, DANIEL W OWNER 07/07/2005
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=PREMIHA950MG 6/15/2007
Look Up a Contractor, Electrician or Plumber License Detail Page 2 of 2
GREAT
AMERICAN
INSURANCE Until
#2 CO FS7781052 07/07/2006 Cancelled $6,000.00 07/27/2006
ACCREDITED
SURETY fi Until
t11 CAS CO 10040159 07/07/2006 Cancelled 07/07/2006 $6,000.00 07/07/2005
Savings Information
No Matching Information
insurance Information
Company Policy Effective Expiration Cancel Impaired Received
Insurance Name Number Date Date Date Date Amount Date
OHIO CAS
000
00
$1
000
06/29/2006
b1 INS CO BH053383254 07/07/2005 07/07/2007 ,
,
.
Summons /Complaints Information
No Matching Information
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https://fortress.wa.gov/lni/bbip/Detail.aspx?License=PREMIHA950MG 6/I 5/2007