20150106 Permit Pkg 02042015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: YELM PRAIRIE CHRISTIAN
Address: P.O. BOX 578
YELM WA 98597
Property Information:
Site Address: 501 103RD AVE NE
Permit No.: 20150106
Issue Date: 24q () J
(Work must be completed within 180 days)
Phone: 360- 458 -7564
Owner: YELM PRAIRIE CHRISTIAN
CENTER
Assessor Parcel No.: 64303601802 Subdivision: MCKENNA IRRIGATED Lot: 2
TRACTS
Contractor Information:
Name: 301 CONTRACTORS LLC
Address:
1813 HARRISON AVE
CENTRALIA WA 98531
Contractor License No.: 301 COCL969JO
Phone:
Expires: 4/20/2016
Project Information:
Project: ROOF
Description of Work:
REPLACE THREE TAB ROOF WITH RAISED SNAPLOCK
Sq. Ft. per floor:
First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
ROOF
Contractor
301 CONTRACTORS LLC
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 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 further certify that I am currently
registered in th ing 1C
Signature Date
Firm
Fees
$ 741.75
$ 741.75
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
(3t�, of Yell
458 -3244
REC #' D0785558
OPER; CO 2 /p4
REF #; 716 3 TERM 001 /2015 4:
PAID 8y: 08 PM
IRAN:
I CO 30.0000
BUSINE ST Aj TOES RS LLC
IRAN: 33. 0000 LICENSE
LENS &
20150106 00 BUILDING 35 04CR
'ELM PRAIRIE 741.7PERMITS
ROpF 501 103RD ASE NE ISTIAN
TENDERED, 741,75CR
APPLIED; 776.75
776 CHECK
CHANGE:
5-
GE;
0.00
Rvso�
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: 0� 2 ,91zen PC Parcel #: -d)4 �
Zoning;
Current Use: rA u re A Proposed Use: S c7 rr-y-
New Construction Model / Re -Roof / Tenant Improvement
Plumbing Mechanical Fire Prevent/Suppress /Alarm - Other
Project Description /Scope of Work: n /,t ee Z Ld Z PLa o/
Project Value: (0a
Building Area (sq. ft) Parking Garage 1s' Floor 2"d Floor 3rd Floor
Building Height 2=4 ;;t I r~f
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER/TENANT NAME- � PCC , t C
ADDRESS `' ^�f / � '3 --d i� EMAIL YPce- ey r^
CITY 1c ,... STATE k. 4 ZIP 2 QJy LTELEPHONE :3t „0 4 r,c[ -75� -1
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR n LEPHONE �J(qD -2,2,0 0'2�Pf
ADDRESS Pb ,r4 SQ EMAIL
CITY L - or34ra l ty-% STATE ZIP ' s2 c i FAX 0) _7 ”-
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
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 #
Copy of City Mitigation documentation JFC).
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.
Applicant's Signature Date
Owner/ Contractor/ Owner's Agent/ Contractor's Agent/ Tenant (Please circle one.)
Y P C C if work authorized by such permit is not begun
ended or abandoned for a period of 180 days
!�
GOD'S PORTION
Always Enough" IAN 2 g 2015
Yelm Prairie Christian Center
Dale Richardson
Director
360- 480 -3556
501 103rd Avenue • Yelm,WA 98597
(360) 458 -3835
(360) 458 -3144 FAX
www.ci.yelm.wa.us
Submission Confirmation Page 1 of 1
NErmy "Working together to fund Washington's future" 7 Yellin Prairie CC Log out ( DOR Home
Locations r Submit confirmation
Nonprofit Property Tax Exemption Renewal
Confirmation
Confirmation Number: 100637
Registration Number: 02342 -002
Tax Year: 2013
Assessment Year: 2012
Date and Time Submitted: 03/14/2012 10:17:08 AM
Make sure you mail in any documentation that was not attached electronically. You must Include the cover sheet for identification purposes.
File on or before March 31, 2012 to avoid late fees.
For assistance call LINDA SMITH at (360) 534 -1416 or send an e-mail.
Print confirmation Return to location list 1)
Need Assistance? 1- 877 -345 -3353
Your Pri—V 1 42007 Washington State Department of Revenue and its licensors. All rights ro—ed,
rX
sll
Lj f U
https: / /fortress. wa. gov /dorlefile /ContentIDoingB usines s IMyAccountlExemptPropertyTaxR... 3/14/2012
Search L &I
-s
301 CONTRACTORS LLC
Owner or tradesperson PO BOX 54
WORTHEY, GARRY WARREN CENTRALIA, WA 98531
360- 330 -0301
Principals LEWIS County
WORTHEY, GARRY WARREN, MEMBER
WORTHEY, TRAVIS WARREN, MEMBER
TUPPER,STACY
(End: 03/08/2012)
Doing business as
301 CONTRACTORS LLC
WA UBI No. Business type
602 371 413 Corporation
License
Verify the contractor's active registration / license / certification (depending on trade) and any past violations.
Construction Contractor Active.
_.._... .... . _.......
Meets current requirements.
License specialties
ROOFING
License no.
301 COCL969JO
Effective — expiration
04/20/2004— 04/20/2016
Bond
No bond accounts during the previous 6 year period.
Insurance
United Specialty Insurance Com
$1,000,000.00
Policy no.
cgd00004917 -01
Received by L &I
Effective d:
09/15/2014
09/16/2014
Expiration date
09/16/2015
Insurance history
Savings
(in lieu of bond) $6,000.00
Received by L &I
04/20/2004
Savings account ID Effective date
0201220050 04/09/2004
Lawsuits against the bond or savings
No lawsuits against the bond or savings accounts during the previous 6 year period.
L&I Tax debts
No M tax debts are recorded for this contractor license during the previous 6 year period, but some debts
may be recorded by other agencies.
License Violations
No license violations during the previous 6 year period.
Renewal Declaration, Reg Num: 02342 -002
rKe' V'' e n 66
iti.ithcnc�`.z�w 4eatr
♦
Page 1 of 3
PROPERTY TAX EXEMPTION RENEWAL DECLARATION
Filing Deadline March 31, 2012
For assistance call LINDA SMITH at (360) 534 -1416
YELM PRAIRIE CHRISTIAN CENTER
PO BOX 578
YELM WA 985970000
Occupant/Location Address:
YELM PRAIRIE CHRISTIAN CENTER
PO Box 578
501 103rd St NE
YELM WA 98597
January 02, 2012
Assessment Year: 2012
Tax Year: 2013
Access Code: NPR002044
County: Thurston 34
Registration No: 02342 - 002
Your exempt status was determined under the following law(s):
84.36.020 CHURCH
The property listed on the enclosed page(s) together with all personal property owned by the applicant
and located onsite is currently exempt from property tax. To maintain the exemption, you are
required to recertify the use of the property annually.
Please review the entire renewal declaration and follow the steps below:
Report changes in use and/or make corrections to the information directly on this form
Provide additional documentation or certification as requested
Sign the certification statement below
Return ALL pages of this renewal form postmarked on or before March 31
I certify that the use of the exempt property listed on the following page(s) is unchanged
except as noted and that all other information is true and correct.
Signed:
Name and Ti
Date:
Phone:
Property Tax Division. P.O.Box 47471 . Olympia, Washington 98504 -7471. (360)534 -1400. Fax (360)534 -1380
https:H fortress. wa.gov /dorlefile /ContentIDoingB usiness IMyAccountlExemptPropertyTaxR... 3/14/2012
Renewal Declaration, Reg Num: 02342 -002
Registration: 02342 -002
2013 Annual Property Tax Exemption Declaration
Please note any changes or conrrection directly on this form and return all pages.
Location Comments:
001 Parcel Number: 64303601802
Page 2 of 3
Legal SEC 19 TWP 17 RGE 2E QUARTER SE SE Plat MCKENNA IRRIGATED
Description: TRACTS; SS -8019 LT 2 Document 022/252.
Status W'LY 5 AC (SITE OF CHUCH & OTHER IMPROVEMENTS) IS
Comments: EXEMPT, REMAINDER IS TAXABLE.
https:llfortress. wa.gov /dorlefile /ContentIDoingB usines s/ MyAccountlExemptPropertyTaxR... 3/14/2012
Garry Worthey 4
Travis Worthey CONTRACTORS LLC 1- 800 - 479 -2301
1718 Harrison Fax: 360 - 736 -2380
Steel Roofs • Siding
rye
PO Box 54 • Centralia, WA 98531
PERMANENT RESIDENTIAL SIDING & ROOFS
Sales Contract and Work Order
Me the owner(s) of the premises mentioned below hereby authorize you as contractor, to furnish all necessary materials, labor and workmanship
to install construct and place the improvements according to the following specifications, terms and conditions, on premises below described.
Name: y 1 Prcur g, Chri�4icr,&► lai r' Phone: o -- -/822 - 3�5 (Q
Address: 10"I Ird �N. Ve Date: I D.°- 1'1 -_ 1
Steel Color: cliff >ice, Design of Panel: chm-to lnc -):
G.A. of STL:— 'qfr, t� Type of Striping: �1►c�
Tt n -2, p( i rcuY Sc'`i- rvoy rod and replo'ut, cr, if•lt'c'_dIC�i-
-3 0 16 Fc 11 papc r es� i 1 I kx- Q p ph ej ju- rc"(Yt 4o e-
rn � � � i-� r� ir�ca� r' �� r , `� (� •.� r ' � �� '"ar►�>, ra�►� c.,..� 6 I I �.
� n -FrJc.cl -ye) 'c- au C �ucw W i+k rAl� A-6 M°a cane y1w6b.i'lc,
i)r icy i,nducte' cxkk l Ac c and Mc et ictl fur C.' ccmj�Aei
(Intl �' ►n nor c��n
(CASH JOBS) Cash Price
50% or more must be paid down on cash jobs. Tax
Payment must be made at time of contract or upon Total
delivery of material. Balance of contract price Down Payment
must be paid on the date of completion or interest Unpaid Balance
at the rate of 1% per month will be charged from
date of completion to date of payment. Total
SPECIAL INSTRUCTIONS
$ 59,t) ; c
$ q 4 &(0i cc,
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Packing List #s 1293649- ;L
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Product Desc: 2SIiCALUMEO Painted 0.01
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Tap Color : DARK (BRAY - CS DC151
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Butt= Color: BACKER - BX DC3.14D -11
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1
4061137
10675514 50693214 Ii 2,367 7
(16.1250 "3 1001204151 UNCALMUO 2,350 Bt1t 2
Z
1031137
1089661S 80662214 1 2,767 2
7
(16.1a50 ^) 100310415D 31'N=VMG 2,300 Post 2,
4451177
10575539 00662220 2,367 7
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