M-05-0292
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
M-05-0292-Yl
Issue Date. 09/21/2005
(Work must be started within 180 days)
Receipt No
38302
Applicant:
Name. Pacific Marine Repair
Phone.
253-272-4302
Address. 1629 EAst Alexander Ave.
City' Tacoma
State. WA Zip 98421
Property Information:
Site Address. 16533 Hwy 507 SE
Assessor Parcel No 64303200704
Subdivision.
Lot:
Contractor Information
Name.
Contact:
Phone.
Address.
City'
State.
Zip
Contractor License No:
Expires.
Business License:
Project Information:
Project: Del's Farm Supply Propane Tank
Description of Work: 3950 gallon Propane Tank for resale
Sq. Ft. per floor (1 st) 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
Mechanical Permit
TOTAL FEES
2500
$25.00
000
000
o 0000
o 0000
Applicant's Affadavit:
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
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restricti of record. If applying as a contractor, I futher certify that I am currently
registered in the State hington.
# Sets of Prints.
Signature
Date
Final Inspection:
Date:~J)~\()~
\
By' 13~
Firm
,J.. .,;, . '<'~" <:" :',.,. : ...:- : THE FACE OF THIS DOCUMENT HAS A RED BACKGROUND -- NOT A WHITE BACKGROUND . ' '.', . :
RE;ce.JPtNo. 38 302
. ."" I
****TWENTY FIVE DOLLARS & 00 CENTS
)
~
~
.)
RECEIVED
(
y
RECEIVED FROM
DEL'S FARM SUPPLY INC
P.O BOX 39039
LAKEWOOD WA 98439-0039
SITE 16633 HWY 507 SE
H-05-029~-YL
DATE
09/21/05
REC. NO.
33302
AMOUNT
'1-
REF NO.
2.5.00 CHEP:K
~ ~ "(,):: f
115162
BUDGETAPY
~, I ;-
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/1'
JANINE
PEHrIT ::? t:; 00
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Applicant:
z.~- uZ'
City ofYelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Name: Pacific Marine Repair
City' Tacoma
Address. 1629 EAst Alexander Ave.
Project Information
Project: Del's Farm Supply Propane Tank
Description of Work: 3950 gallon Propane Tank for resale
1 t;"'~
Permit Fees Schedule
Permit No M-05-0292-YL
Phone'
253-272-4302
State: WA Zip 98421
Site Address. 16533 Hwy 507 SE
Assessor Parcel No. 64303200704
Fees:
Item
Mechanical Permit
032001-322-10-00
000
Item Fee Base Amt Unit Fee
000
Acct Code
2500
TOTAL FEES
$25.00
Unit Rate No. Units Unit Desc
0.0000
o 0000
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TOP VIEW
SPH~ERE CEMENT PAD
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Cement pad minimum compression strength ::: 2,000 pst
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1629 IE. ~rA~~
Tacoma? WA.98421
Ph: 253-212-4302
fax: 2~212-3096
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Project Address:
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
IfR5"33 i-/lj SO ') 5e--~/1Nt Parcel #. 4Y3,j ~L-CJ lJ 7e?L/
CurrentUse 'K.-e+ct</ Proposed Use f2e ~I-l Received
SEP 1 4 2005
Zoning;
U New Construction U Re-Model/ Re-Roof I Tenant Improvement
U Plumbing U Mechanical U Fire Prevent/Suppress/Alarm p< Other
Project Description!Scope of Work: :r fA.&-fq tI he/A) fV"OftltYl-e., -i-t-th../<'" a.V\.d ,J{5P~~.V'
Project Value: .:/f;}-(!). 0 0 0 ~
I
Building Area (sq. ft) Parking Garage
Building Height
1st Floor
2nd Floor
3m Floor_
Are there any environmentally sensitive areas located on the parcel?
completed environmental checklist must accompany permit application
If yes, a
BUILDING OWNE ENANT NAME.
ADDRESS
CITY STATE ZIP
Vlc.
ARCHITECTIENGINEER
ADDRESS
I CITY STATE
LICENSE #
EMAIL
TELEPHONe
ZIP
GENERAL CONTRACTOR Pttc.('t't(... ~",e.-. e-,.1.' y TELEPHONE 2}{'~ 272-
ADDRESS /6ZCf E:AI-eKa~ ~ EMAIL
CITY -rG\COVI-I-~ STATE w ~ ZIP '18c.j2--1 FAX 2.S'3 '2-'72.. 3!)qb
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
Ljgo "1-
PLUMBING CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
ZIP
MECHANICAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
ZIP
Copy of City Mitigation documentation (TFC).
I hereby certify that the above Information 15 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 Y
9-/1-0 cs-
pplicant's Signature . Date
Owner I Contractor I Owner's Agent I Contractor's Agene~ (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
PO Box 479
Yelm, WA 98597
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wa.UB
r~t-
F~r)( L S 3 ~ '2. 7 "7 9 7 r
~ '"2-.~ 3> l{ b 5" "2 s-o .5
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General/Specialty Contractor
A business registered as a construction contractor with Uti 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 PACIFMR022M1
Licensee Name PACIFIC MARINE REPAIR INC
;, Licensee Type CONSTRUCTION CONTRACTOR
, 600165299 ,Y .e[jfY.WQ[k,er~C.omp..eI.emi!Jm
UBI StatlJ~
Ind. Ins. Account
Id
Business Type CORPORATION
i Address 1 1629 E. ALEXANDER AVENUE SUITE
Address 2
City TACOMA
County PIERCE
.; State WA
Zip 98421
Phone 2532724302
Status ACTIVE
Specialty 1 BOilER/STEAM FIT /PROC PIPING
Specialty 2 WELDING
Effective Date 7/21/1998
" Expiration Date 10/512005
Suspend Date
i Separation Date
Parent Company
Previous License
Next License
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License
https.//fortress.wa.gov/lmlbbIp/Detml.aspx?LIcense=P A CIFMR022M 1
9/2012005
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Page 2 of3
h
Business Owner Information
Name Role Effective Date Expiration Date
RAYMOND, GARY A PRESIDENT 07/21/1998
RAYMOND, DONNA L SECRETARY 07/21/1998
Bond Information
Bond Bond
Company Account Effective Expiration Cancel Impaired Bond Received
Bond Name Number Date Date Date Date Amount Date
.. Until
#2 CBIC SB5888 10/03/2001 Cancelled $6,00000 10/05/2001
#1 CBIC SB5888 07/21/1998 10/03/2001 $4,00000
'....,. .... ,... ....,...
Savings Information
No Matching Information
Insurance Information
Company Policy Effective Expiration Cancel Impaired Received
Insurance Name Number Date Date Date Date Amount Date
EVANSTON INS
#10 CO 04PKGOO775 09/01/2003 09/01/2006 $3,000,000 00 07/26/2005
EVANSTON INS
#9 CO 02PKGOO775 09/01/2002 09/01/2003 $3,000,000 00 09/12/2002
ROYAL
.#8 SURPLUS LINES KZE530516 09/01/2002 09/01/2003 $3,000,000 00 08/21/2002
#7 GULF INS CO GU0691828 09/01/2001 09/01/2002 09/04/2001
ROYAL
SURPLUS LINES
#6 INS CO TBA 09/01/2001 09/01/2002 09/04/2001
., GULF
UNDERWRTRS
#5 INS CO GU0691828 09/01/2001 10/01/2001 09/04/2001
#4 GULF INS CO GU0691828 09/01/2000 09/01/2001
EVANSTON
INSURANCE
#3 COMPANY TBD 09/01/2000 09/01/2001
UNITED
CAPITOL INS
#2 CO GLA 1050019 09/01/1999 09/01/2000
COMMERCIAL
UNDERWRITERS
#1 INC EWC5000418 07/21/1998 09/01/2000
Summons I Complaints Information
No Matching Information
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About LEI I Find a
1-800-547-8367
at LE! I Informacion en espanal I Site Feedback I
vashington State DepL ofabor and industries. Use of this site is subiect to the lar; of Ie
.>tate or Washmgton
Access A12reement I PriV0c and s<.'curity statement I Intended usef !mal conteM ,olicy Visit access.wa 'lov
Staff onl', link
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