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Lowell Williams - EXP 12/31/2021 City of yeCm OCCUPATIONAL PERMIT APPLICATION Permits issued by the City of Yelm are valid in Yelm, Olympia, Tumwater, and Lacey. CINew Permit ❑Renewal (Permit# ) I hereby request a permit to work in the following business, trade or occupation in accordance with all laws and/or ordinances governing such business, trade or occupation in the City of Yelm.(YMC 5.03) IMPORTANT: For new permits,complete all requested fields. For renewals,complete those fields marked with a star (*)plus any other fields containing information that has changed since your last application was submitted. *PERMIT TYPE (Check one) ❑For-Hire Driver ❑Locksmith I►JSolicitor APPLICANT INFORMATION *Full Legal Name: (F/M/L) L© we I I C,ct g+€R W I1 1 ict /M 5 Other Name(s) Used: (if additional space is needed, use the back of this page) (F/M/L) (F/M/L) Sex 61 *Date of Birth 15 Sc4,)Pl8'f *Age 36 SS# *Height 5' 10 *Weight 16S *Hair Color BrowA) *Eye Color Gree. Place of Birth I'h o ft -5--vw 4 7"."'L1 Have you ever had an occupational permit suspended or revoked? ❑Yes I No If, "yes," when and where HOME ADDRESS (Do not use a P.O. Box for your street address, please) *Street 10 3 3 y >o t, () ) Loo/ *City Ye A^ *State L'')A" *ZIP q 8597 *Phone 9/6- Q/Z' / 72.3 Cell *Mailing address ( same *email L owe I(e "The f'e c e kedee,0►kn Page 5 of 9 OTHER RECENT RESIDENCES List all other states and cities where you have lived in the past five (5) years. From To State City (month/year) (month/year) 1 Cal*e(,v.4 Vac( u 'Ile self 2.014 self 2( !7 2 3 4 5 BUSINESS INFORMATION (the business that is related to this permit) *Business Name DN IC E E. S koo Pets` Business Owner/CEO Lowe ft l,J,' (;a pm 3- tg Applicant Street 1 0 3 3 9 Pur k U ew L 0 City ' State wit ZIP Phone 9/6- 1 (2 - 1723 Cell Email Lowell ®fie. Fete ktete2.oTelm Business License# EMPLOYMENT HISTORY Including your current employment, list the jobs you've held during the past five (5) years. Job Title Employer City/State From/To 1 Gt& Mu NA K. fl.e kece (re etc& Yw>4 2015 -pe.Sr, - 2 3 4 5 *CRIMINAL HISTORY (Self-disclosure) In the past five (5) years, have you been convicted of any of the following offenses? Offense Type Yes No 1 Any felony 2 Larceny/theft/vehicle prowling 3 Domestic violence 4 Fraud/Identity theft /C 5 Any drug-related crime 6 Any sex offense 7 Any crime against children or vulnerable adults Page 6of9 If you are applying for a Solicitor's Permit or a For-Hire Driver's Permit, complete the appropriate Supplemental Information section that follows. For any other type of permit, skip to the "Application Document Checklist" section. SUPPLEMENTAL INFORMATION — SOLICITOR PERMIT APPLICANTS ONLY YMC 05.03.200 Qualifications 1. Briefly describe the products or services for which you will be soliciting. o , waSfe St,00/),•,v3 geMouw ( C + Bak Ma,4etiwce. 2. Please list all vehicles you will be using in your business. (Use the back of this form for additional vehicles, if necessary) Vehicle 1 Vehicle 2 Year ZOOS Make TOYo-i-ci Model *Theo Ma Color Plate# State TeN,ti Owner Lowell �Il,ai.►s Vehicle 3 Vehicle 4 Year Make Model Color Plate# State Owner Page 7 of 9 SUPPLEMENTAL INFORMATION — FOR-HIRE DRIVER PERMIT APPLICANTS ONLY YMC 05.03.030 Qualifications (self disclosure) Qualification Yes No 1 Have you had a valid Driver's License for the past two years? is If yes, in what state(s)? 2 Are you 18 years old? 3 Do you have any physical or mental infirmities that may affect your driving? 4 Have you been convicted of three (3) or more moving violations during any one (1) year period in the past five (5) years? 5 In the past five (5) years, have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs? 6 In the past five (5) years, have you been convicted of having physical control of a motor vehicle while under the influence of alcohol or drugs? 7 In the past five (5) years, have you been convicted of negligent driving or reckless operation of a motor vehicle? 8 In the past five (5) years, have you been convicted of vehicular homicide or assault with a motor vehicle? *All applicants must complete this section APPLICATION DOCUMENT CHECKLIST You need to do the following things before your application will be processed. Use this checklist to make sure you have all the materials you need. El/Submit a copy of your driver's license or, if no current driver's license, your State-issued ID card. Provide an ID photo. Of Have your fingerprints taken at YPD. NIA ❑ Submit a copy of your complete driving record (for-hire driver/operator applicants only). Submit your completed and signed application form. ❑ Pay your fees (cash, check or debit card). Page 8 of 9 CERTIFICATION Under penalty of perjury, I swear that all information contained in this application is true, accurate and complete to the best of my knowledge and belief. I also hereby authorize the City of YeIm to conduct any reasonable inquiries, including examination of my criminal history, necessary to verify the information I have provided and determine my fitness for the permit for which I have applied. I understand that the City may, at its expense, conduct additional criminal history checks on me at any time while I hold an occupational permit issued under YMC 5.03, and I hereby consent to such checks. Signatu Date IDec2 rt I request a copy of the criminal history data used to determine my fitness for a permit. City use only below this line Date Received Reviewed By Review Date pproved ❑Denied Reason: ❑Incomplete application El Criminal record ❑Prior permit revocation ❑False information ❑05.03.060 ❑Other (specify) ❑Fees paid: Permit# ❑Base fee refunded: Date ermit ID completed; pplicant notified By ‘WIt Date ?/( ❑Permit fee only (non-fingerprint renewal) Page 9 of 9 WA ..�s� IDENTIFICATION CARD I LIFO , DRIVER LI 7-. usA �M t_ � DL � a«'" �. rY aiducuWILLILC163LN • WILLIAMS x SC zLOWELL CARTER EXP 06/1512020 END NONE _ LN WILLIAMS 3009 06/15!1984 ae1ss10l11/2017 . == . FN LOWELL CARTER s 1034 PARKVIEW LOOP 742 N HAMPTON DR , VACAVILLE,CA 95687 Y 15 S WA 98597-8604 DOB gWt_ 15 SEX M 18 EYES GRN„. ,, RSTR NONE a 08151984 . 16 HGT 5'-10" tT WGT 170,1b ae EXP Os/ SEX M HAIR. S GRN kl***t MGT 5'-10" WGT 170 lb 5DD WILLILC163 D1235 o1108Rois CC 00,27l2016688051CCE0,2o 05/27!2016 ._. REV 18168•126660820101 1111111111111111111111111111111111111111 11111111111 LICENSING IN SG 211725810294825302 IIIIIIIIIII�IIIII�IIIIIIIIIIIIIIII a CLASS:C- N- .Nonew/GVW526000,No M/C `,' ENDORSEMENTS:None illtili' ' 6 1liefillifilillIRESTRICTIONS:None TT I�L i 'r1 (] ��•l�i•'1 ligillig IThh&enseisor minaIIkensetoea rentor vehk ;q Toes not✓l establish eligibility Mt empbynent ,� voter registration or Roblk benefits. Rev 04/18/2010 06115/1986 Pksve no*R1 the Department o1 Lln.oµywithin 10 drys M.change al.6oreza. • F:01 " /OT THS YELM WASHINGTON OCCUPATIONAL PERMIT MASTER APPLICATION PACKET For the following Occupations: For-Hire Driver (Taxi) Locksmith Solicitor YMC Chapter 5.03 Ordinance No. 953 Effective January 25, 2012 Occupational Permits issued by the City of Yelm are valid in Yelm, Olympia, Tumwater and Lacey. Revised October 2016 Occupational Permits (YMC 5.03) APPLICATION INSTRUCTIONS New Applications • You must submit a "new application" if any of the following apply to you: 1) You are applying for an occupational permit for the first time; or 2) You had a permit in previous years but did not have one last year; or 3) You had a permit last year but it was suspended during the year. • If you are required to submit a "new application," check the "New Permit" box, and complete all the information requested on the application form. • If you checked Solicitor or For Hire Driver in the permit type, be sure to complete the appropriate Supplemental Information section. • Get your fingerprints taken by Yelm PD with Picture ID required. This must be completed before your application will be processed. Yelm PD does fingerprinting from 9:00 am through 11:00 am and 1:00 pm through 3:00 pm depending on staff availability, Tuesday through Thursday. No appointment is necessary. Proof of$10.00 payment must accompany service. • Driver For Hire, applicants must submit a copy of their complete driving record. This record may be obtained from the Department of Licensing and will require the payment of a fee at the applicant's expense. This requirement applies only to For Hire vehicle driver/operator permit applicants. Bring your application materials to the City Business License service counter to turn them in; you can pay your permit fee by check, cash or money order at the service counter. If you submit your application materials by mail, enclose a check or money order for the amount of the permit fee and any other applicable fees. Make checks or money orders payable to the City of Yelm. • Permit fees. The current initial fee for the Occupational Permit is $70.00 per year and any portion thereof. ($10.00 Permit fee; $50.00 WSP/FBI record check fee; $10.00 for 2 fingerprint cards), plus a separate $35.00 City of Yelm Business License Application to do business in Yelm). • If you pay by check, be aware that your permit will not be released to you until your check clears. Permit Renewal • You are eligible to renew your permit if all of the following apply to you: 1) You have a permit issued by the City last year for the same occupation that you're applying for this year; and Page 2 of 9 2) Your permit was not revoked or suspended during the year. • If you are eligible to submit a "renewal application" check the "Renewal" box on the application form, enter your permit number from last year, and complete all information on the application form marked with a star(*). You must also complete any other information requested on the application form that has changed since you submitted your prior application. • Renewal applicants must be fingerprinted and provide a photograph every fourth year. Fingerprinting and providing a picture must be completed before your application will be processed. Yelm PD does fingerprinting from 9:00AM through 11:00AM and 1:00PM through 3:00PM depending on staff availability, Tuesday through Thursday. No appointment is necessary. Fingerprinting costs are $10.00. • For-hire driver/operator renewal applicants must submit a copy of their complete driving record. This record may be obtained from the Department of Licensing and will require the payment of a fee at the applicant's expense. This requirement applies only to for- hire vehicle driver/operator permit applicants. • The current annual fee for new Occupational Permits is $70.00 per year or any portion thereof. The fee for renewal permits is $30.00 in a year when you are not required to be fingerprinted, and $70.00 in a year when you are required to be fingerprinted. • Bring your application materials to the City Business License service counter for review and payment. You can pay your fees by check, cash or money order at the service counter. Make checks or money orders payable to the City of Yelm. If you pay by check, be aware that your permit will not released to you until your check clears. Review and Issuance Process • The Police Department will review your application materials and determine if you are eligible for the Occupation Permit for which you have applied. Normally, that process takes about ten (10) working days, but it may take longer, depending on when the City receives criminal record data from the Washington State Patrol. • You will be contacted when a decision has been made on your permit. If you are approved, you must come to City Hall in person to pick up your permit card. To assure that permit cards are actually received by the person to whom they are issued, we check the photo on the permit with the person picking up the card at the time we release the card. For your protection, we do not mail out permit cards or release them to third parties. If you are denied, your will be notified by Yelm PD with the reason(s) for the denial and the process you may use to appeal the decision, if applicable. • If your permit is denied for any reason, you will be refunded the permit fee. The background check and fingerprinting fees are non refundable. Page 3 of 9 • You may request a copy of the criminal history record check data that was used in determining your fitness for a permit by checking the box in the "CERTIFICATION" section of the application at the time you submit the application. If you request this data, you will receive a copy at the time you pick up your permit. If your permit is denied and you requested a copy of your criminal history data, you will need to pick up your copy in person at the Police Department within ten (10) working days of the time you receive your denial notice. The City destroys this data after a decision has been made to issue or deny a permit, so, unless you request a copy at the time you submit your application, we will not be able to provide you with a copy of your criminal history data. Things to Know About Your Permit • Permits are good for the calendar year of issue only. It is your responsibility to get a new permit each year. No reminders or renewal notices are sent out. You can apply for renewal any time after October 1. Plan ahead to get your permit renewed well before the start of each new year. • There is no grace period for renewing a new permit. Current year permits expire at midnight on December 31, and you cannot lawfully engage in a permitted occupation after that time until you have your renewed permit in hand. • Permit fees are for the calendar year of issue (or any part thereof). Fees are not prorated. • Renewal stickers must be affixed to the permit card in the proper location in order to be valid. • Occupational permits are not business licenses. It is your responsibility either to have an appropriate, valid business license yourself, if required, or to be working under a valid business license issued to your employer. • Some occupational permits have specific rules and regulations pertaining to how and when they can be used. It is your responsibility to be familiar with the rules and regulations that apply to your permit type. [see YMC Chapter 5.03] www.ci.yelm.wa.us or request a copy. • Occupational permits may be suspended (i.e., taken away temporarily) or revoked (i.e., taken away permanently). It is your responsibility to make sure you know the conditions that can lead to those actions. [see YMC Chapter 5.03.060] • Occupational permits issued by the City of Yelm are valid in Yelm as well as Olympia, Tumwater, and Lacey. • Finally, misuse of Occupational Permits can result in civil and/or criminal liability. Be sure to follow the rules, regulations and requirements in the Yelm Municipal Code. [see YMC Chapter 5.03.300] Page 4 of 9