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20100173 Permit Pkg 08312010City of Yelm Community Development Department Building Division Phone: (360) 458-8407 Fax: (360) 458-3144 Applicant: Name: SEARS Address: 1024 FLORIDA CENTRAL PARKWAY LONGWOOD FL 32752-2290 Property Information: site Address: 309 MCKENZIE AVE SE owner: Assessor Parcel No.: 64420700600 Subdivision: Contractor Information Permit No.: 20100173 Issue Date: 8/31/2010 (Work must be completed within 180 days) Phone: 800-419-4663 JEAN MCDONALD Lot: Name: SEARS Phone: Address: 1024 FLORIDA CENTRAL PARKWAY LONGWOOD FL 327522290 Contractor License No.: SEARSH1011 LA Expires: 12/31/2010 Project Information: Project: ROOF Description of Work: REROOF Sq. Ft. per floor: First Second Third Garage Basement Fees: Item ROOF Contractor SEARS TOTAL FEES: Applicant's Affidavit: I certify that I have read and examined the information contained within the application and know the same to be true and casrect. I a4so certify that the proposed structure is in conformity with atl 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 further certify that I am currently registered in the Stat~,ef~llashing Date l5 - ~~ ~ ; Heat Type (Electric, Gas, Other): Fees $ 25.00 $ 25.00 OFFICIAL USE ONLY # Sets of Prints: Final Inspection: Date: By: ~T ~~,~~,a~ ~~~r~ C:. ~ ,•. tie ~_ ~ ~. 7 ,.; : J r,~'Fi,~i a ,t~ , ~{~ r,... r pn ~'-' i ~1~: - - ~` ,` r .',4~' " ~` 1ei1 J , -e -~ ,..; ; .., ((}} .:~ ,_~~, i ,~ _~,' i, ns ~ _~_. 1~..`~11i'F1 i~ ` '____ _ !l, j'i 1 ~o~ a ~~73 ~i CITY OF YELM RESIDENTIAL BUILDING PERMIT APPLICATION FORM • Project Address: .~= C~1 /~'~ x~/~~ ~ L~ Parcel #: • Subdivision:- Lot #: Plan #: Zoning i New Construction ~ >JRe-Model / Re-Roof /Addition ~ ~ Home Occupation Sign Plumbing Mechanical Mobile 1 Manufactured Home Placement ~ ' Othe1r Project Description/Scope of Work: '~~~ /~~ ~~/~~~ ~{ Project Value: Building Area (sq. ft) # Bedrooms- PLUMBING CONTRACTOR TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE MECHANICAL CONTRACTOR TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE 13' Floor 2nd Floor Garage Deck Basement Carport Patio # Bathrooms- Heating: GAS/OTHER or ELECTRIC (Circle One) 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. j/~ O~(J Applicant's Signature D 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 YeLm Avenue West Yeim, WA 98597 www.ci.yelm. wa. us (360) 458-3835 (360) 458-3144 FAX Are there any environmentally sensitive areas located on the parcel? !f yes, a completed environmental checklist must accompany permit application. Contractors or Tradespeople Detail Washington State Department of Labor & Industries Contractors or Tradespeople Detail Return to List > Start a New Search > ~ Printer friendly Verify Workers' Comp Premium Status Check for Dept. of Revenue Account Page 1 of 3 About General/Specialty Contractor A business registered as a construction contractor with I.&I 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. Business and Licensing Information Name SEARS HOMEIMPROVEMNTPRODINC UBINo. ~ 601671145 Phone Na. (407) 767-0990 Status ~ Active Address 1024 Florida Central Pkwy Suite/Apt. License No. SEARSHI011 LA City Longwood License Type ~ Construction Contractor State FL Effective Date 6/ 1 / 1999 Zip 32750 Expiration Date 12/27/2011 County Out Of State Suspend Date Business Type Corporation Parent Company Specialty 1 ~ General Speclalry 2 ~ Unused Other Associated Licenses Specialty Specialty Effective Expiration License Name T Ype Status 1 2 Date Date AMERICAN HOME Construction AMERIH1044MA General Unused 7/1 /1 996 6/1 /1999 Archived IMPRVMT PROD INC Contractor AMERICANWINDOWS& Construction AMERIWS054RA General Unused 12/1/1995 11/15/1996 Archived SASH INC Contractor Business Owner Information ;,~ Hide All Name Role Effective Date Expiration Date FEINBERG, MEL J O1 /O1 / 1980 BOYD, JOHN T O1 /O1 / 1980 https://fortress.wa.gov/lni/bbip/Result.aspx 09/01/2010 Contractors or Tradespeople Detail Page 3 of 3 Infraction /Citation Date RCW Code Type Status Violation Amount NMULL00286 5/4/2007 18.27.114 RCW CONSTRUCTION INFRACTION Satisfied $500.00 NMULL00284 4127/2007 18.27.200 RCW CONSTRUCTION INFRACTION Satisfied $1,000.00 © Washington State Dept. of Labor and Industries. Use of this site is subject to the laws of the state of ~cce3s Washington. r~11'ashingtonw ~. 1..,,., ~,,;i~rii 4rh 3114 hops://fortress.wa.gov/lni/bbip/Result.aspx 09/01 /2010