07-0417 Permit Pkg 121907~OF 1FiFA~~ City of Yelm
~~ Community Develo
Building Division
Phone: (360) 458-8407
YELM Fax: (360) 458-3144
Applicant:
Name: Pat's Plumbing
Address: P.O. Box 4447
Property Information:
Site Address: 306 McKenzie
pment Department
City: Federal Way
Assessor Parcel No 75300801100 Subdivision
Name: Applicant Contact:
Address: City:
Contractor License No: Expires:
Project Information:
Project: Kim Buccarelli Gas Piping
Description of Work: Gas Piping
Phone:
State: Zip:
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
----------- ----------- ---------- --------- --------- ---------
Plumbing Permit 25.00 20.00 0.00 7.0000 0.0000 Fixture
TOTAL FEES: $25.00
Applicant's Affadavit:
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 Washington.
Signature ~}' p \ f Date ~ 2 - ~ °~ - ~~
-`~' J
Firm - - -
Permit No: BLD-07-0417-YL
Issue Date: 1 211 912 0 0 7
(Work must be started within 180 days)
Receipt No: 51605
Phone: 360-352-8588
State WA Zip 98063
Lot:
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date: I`~ ~'
By: j
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~~ RECEIPT No. - - J
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SEE
~ f?ECEIVEI)
* ~ * *TWENTI' FIVE DOLLARS & 00 CENTS
f~l t',[ I';~~~"'~ I ~~~r ~,fr1 [ikTl: RFC, N~_). Ah1l}~~{~~ f ~;[F fJ~`1
FAT'S PLUMBING INC 12/19/07 51605 25.00 CHECH 4282
30459 MILITARY RD S
PO BOX 4447 BUDGETARY
FEDERAL 4JAY WA 98063
ttICHELLE
-t~LD-07-0917-I'L -
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General/Specialty Contractor
A business registered as a construction contractor with L131 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 PATSPI'083N5
Licensee Name PAT'S PLUMBING INC
Licensee Type CONSTRUCTION CONTRACTOR
UBI 601397959 Verify Workers Comp Premium
Status
Ind.lns. Accouldt 54986501
Business Type CORPORATION
Address 1 PO BOX 4447
Address 2
City FEDERAL WAY
County KING
State WA
Zip 98063
Phone 2538544080
Status ACTIVE
Specialty 1 GENERAL
Specialty 2 UNUSED
Effective Date 8/25/1992
Expiration Date 4/8/2008
Suspend Date
Separation Date
Parent Company
Previous License PATSP"123C9
Next License
Associated
License
Business Owner Information
Effective Expiration
Name Role Date Date
ROUSER (PETERSON),
LINDA J PRESIDENT 08/25/1992
Bond Information
Bond Bond
Company Account Effective Expiration Cancel Impaired Bond Received
https://fortress.wa.gov/lni/bbip/Detail.aspx?License=PAT'SPI*083N5 I2/I9/2007
Look Up a Contractor, Electrician or Plumber License Detail Page 2 of 3
Bond Name Number Date Date Date Date Amount Date
FEDERATED
MUTUAL INS Until
#6 CO 9864891 08/25/2005 Cancelled $12,000.00 08/03/2005
DEVELOPERS
SURETY ii Until
#5 INDEM CO 136006C 03/21/2002 Cancelled 08/25/2005 $12,000.00 04/08/2002
DEVELOPERS
SURETY it
#4 INDEM CO 136006C 12/29/2000 03/21/2002 $6,000.00 07/25/2001
DEVELOPERS
#3 INS CO 136006C 07/01/1993 12/29/2000 $6,000.00
DEVELOPERS
#2 INS CO 135756C 05/01/1993 07/01/1993 $6,000.00
DEVELOPERS
#1 INS CO 111668C 07/01/1992 07/01/1993 $4,000.00
Savings Information
No Matching Information
Insurance Information
Effective Expiration Cancel Impaired Received
Insurance Company Name Policy Number Date Date Date Date Amount Date
FEDERATED
#15 MUTUALINS CO 9224603 11/26/2006 11/26/2008 $1,000,000.00 11/09/2007
FEDERATED
#14 MUTUALINS CO 9224602 11/26/2005 11/26/2007 $1,000,000.00 10/27/2006
FEDERATED
#13 MUTUALINS CO 5039311 11/26/2004 11/26/2005 $2,000,000.00 11/24/2004
NATIONWIDE
#12 MUTUALINS CO ACP7501027758 03/21/2003 03/21/2005 $1,000,000.00 03/25/2004
NATIONWIDE
#11 MUTUALINS CO ACP7501027758 03/21/2002 03/21/2003 $500,000.00 03/25/2002
UNITRIN PROP 8
#10 CASUALTY CPA176203202 03/21/2001 03/21/2002 04/04/2001
TRINITY
UNIVERSAL INS
#9 CO OF KA CPA176203202 03/21/2001 03/21/2002 02/21/2001
TRINITY
UNIVERSAL INS
#8 CO OF KS CPA176203201 03/21/2000 03/21/2001
TRINITY
#7 UNIVERSAL INS PENDING 03/21/1999 03/21/2000
TRANSPORTATION
#6 INS CO 6136515109 03/21/1999 03/21/2000
#5 CNAINS CO 6136515109 03/21/1997 03/21/1999
#4 CNAINS CO 1036515109 03/21/1996 03/21/1997
AETNA CAS ti
#3 SURETY CO 81MP0024716017 03/21/1995 03/21/1996
AETNA LIFE IY
#2 CASUALTY 81MP23550789 03/21/1994 03/21/1995
#1 FEDERATED INS 9191066 03/21/1992 03/21/1995
Summons /Complaints Information
No Matching Information
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https://fortress.wa.gov/lni/bbip/Detail.aspx?License=PATSPI*083N5 12/19/2007
12/19/2007 wso 13:16 rax
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FOsR~M
Project Address: 3d~- S~./ /Kc /l~„ ¢ j c ~}vc Parcel #: 7S 3 OG y ~ / ~OCJ
Subdivision: Lot #: Zoning;
^ New Construction~s ^ Re-Model / Re-Roof /Addition ~ 1 Home Occupation Sign
^ Plumbing ~t?'Mechanical ^1Mobile /Manufactured Home Pla1cement ^ Other
Project Description/Scope of Work:_T.. 3 / ~ ~ ~ 9e J ~~ ~ c ~c k ~^7a ~ ~ n ('., n ~ G
Project Vaiue:
Building Area (sq. ft) 1u Floor 2"O 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.
fm002/004
4UI~CHA~1~G}~L<iwL~Y~3I~ TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'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 conslrucNon on, and the occupancy and the use or the
above described property will be in accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
~a l 9~ c
Applicant' ature Date
Owner ontracto /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 (860) 458-3835
PO Rnx 479 (360) 458-3144 FAX
Yelm, WA 98597 wu~w.ci.yelm.wa.us
12/19/2007 WED 13:16 FaX
IQJ004/004
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12/19/2007 WED 13:16 FAX
PAT'S PLUMBING
P.O. Box 4447 • Federal Way, WA 98063
Tel: 800-491-4081 • Fax: (253) 946-0171
Date: I a /I ~ /~ ~
To: GGY`1nK/~i/~/ ~c/c./e~+µ'tca fi
Firm:
Fax Number: 360 - Yom,. 3 / y~
From:
# Of Pages Including Cover:
Comments:
P~~r',~~ .~p~~,c,.~,~ ~l 3G( Sc./ /`(~ ~<cn 2;c /tic .
®001/004
** We don't want to do just one job for you, we want to be
your plumber!!**