DEMO-05-0234
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 ~T~ .1.J1~ _ Date ?-A- 0"
Firm ~
~
~
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: Julson, Leonard
Address. POBox 1687
City' Yelm
Property Information:
Site Address. 9211 Wilkerson Rd. SE
Assessor Parcel No. 22718440600
Subdivision.
Contractor Information:
Name. Dent National Inc.
Contact:
Address. P.O Box 231
City' Pacific
Contractor License No. DENTNI*077JR
Expires. 08/15/06227
Project Information:
Project: Leonard Julson
Description of Work: Move House out of County
Sq. Ft. per floor' (1st) 0
(2nd) 0
(3rd) 0
Heat Type (Electric, Gas, Other).
Fees:
Item
Item Fee
Base Amt
Unit Fee
Building Permit - Other
TOTAL FEES.
5000
$50.00
0.00
000
Applicant's Affadavit:
Permit No DEMO-05-0234-YL
Issue Date 07/28/2005
(Work must be started within 180 days)
Receipt No
37621
Phone:
458-7696
State. WA Zip 98597
Lot:
Phone. 206-246-5999
State. WA Zip 98047-231
Business License.
Garage 0
Basement 0
Unit Rate
No. Units Unit Desc
0.0000
o 0000 $1 000
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date: f.ff'1Jr
By'
RECEIVED
". * ",. * F I F T 'Y D 0 I. L })... P 3 ('( ) (1 (, t~ ~; l' ;':1
RECEIVED FROM
JUL.::iON, LEONAPD
POBOX 16"\'
YELll \'II~ 9....597
DATE REC NO
07/28/05 3/r21
fJUfjGETAF'Y
HI ('HE.uLE
)
.-
D I~ r 1 () - (,) 5 - \J 2 j S - '{ Ii
RECEIPT No 37621
AMOUNT F1EF NO
50 (} 1.1 (I ~;:\ S f{
c
c
c
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Add'iJ 159;;' J Y:;~S(j(''''<</) I Parcel #' ,?;; 7 1$ Y'I Vt-t:!Jl!
Subdivision. Lot #. Zoning;
u New Construction U Re-Model/ Re-Roof / Addition U Home Occupation Sign
U Plumbing U Mechanical U Mobile I Manufactured Home Placement U Other
Project Description/Scope of Work:
Project Value.
Building Area (sq. ft) 1st Floor
Basement
2nd Floor
Carport
Garage
Patio
Deck
# Bedrooms_
# Bathrooms_
Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
completed environmental checklist must accompany permit application
If yes, a
BUILDING OWNER NAME. /".J? I'J? A/ A JJ.p_ J LIt.. 6 n IV
ADDRESS ' 1 EMAIL
CITY TELEPHONE
ARCHITECT/ENGINEER
ADDRESS
CITY STATE
LICENSE #
EMAIL
TELEPHONE
ZIP
GENERAL CONTRACTOR
ADDRE~_ :; 3 I
CITY f/"'c~ I~ STATEW.I\, ZIP
CONTRACT~R'S LICENSE #
lELEPHONE
EMAIL
91J6l)7 FAX
EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR
ADDRESS
CITY STATE ZIP
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
ZIP
Copy of mitigation agreement with Yelm Community Schools, jf applicable.
I hereby certify that the above information is correct and that the construction on, and the occupancy and the use ofthe
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 I Owner's Agent I 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
PO Box 479
Yelm, WA 98597
67 7~R
~t) I <-11-' .GI 9
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wa.us
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A business registered as a construction contractor with L&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
License Information
License DENTNI*077 JR
; Licensee Name DENT NATIONAL INC
Licensee Type CONSTRUCTION CONTRACTOR
UBI 601459619 Verify Workers Camp Premium
status
Ind. Ins. Account 84248000
Id
Business Type CORPORATION
Address 1 PO BOX 231
Address 2
City PACIFIC
County KING
State WA
Zip 980470231
Phone 2062465999
Status ACTIVE
Specialty 1 GENERAL
Specialty 2 UNUSED
Effective Date 4/19/1993
Expiration Date 8/1512006
Suspend Date
Separation Date
Parent Company
Previous License
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License
,..........,
Business Owner Information
II
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7/28/2005
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Name Role Effective Date Expiration Date
AHOLA, PENNY L 01/01/1980
; DUGGAN, JERRY 01/01/1980
PETTIT, SAM J 01/01/1980 01/01/1980
FERGUSON, DALE C 01/01/1980 01/01/1980
Bond Information
Bond Bond
Company Account Effective Expiration Cancel Impaired Bond Received
Bond Name Number Date Date Date Date Amount Date
DEVELOPERS
SURETY ft Until
#1 INDEM CO 855475C 09/04/2001 Cancelled $12,00000 09/05/2001
"
Savings Information
Bank Assignment
Bank Branch of Savings Effective Release Assignment Impaired Received
Savings Name Location Number Date Date Type Date Amount Date
#1 SEAFIRST 55362446 04/15/1993 07/24/2002 Bond $6,000 00 4/15/1993
'....
Insurance Information
Company Policy Effective Expiration Cancel Impaired Received
Insurance Name Number Date Date Date Date Amount Date
WESTERN
NATIONAL
#9 ASSUR CO SCP0520967 07/31/2005 07/31/2006 $1,000,000 00 07/26/2005
.. WESTERN
HERITAGE
#8 INS CO SCP0520967 07/31/2004 07/31/2005 $1,000,000 00 07/31/2004
.. WESTERN
HERITAGE
#7 INS CO SCP0430622 07/31/2003 07/31/2004 $1,000,000 00 07/31/2003
WESTERN
NATIONAL
#6 ASSUR CO SCP0334071 07/31/2001 07/31/2003 $1,000,000 00 08/15/2002
WESTERN
NATIONAL
#5 ASSUR CO TBD 07/10/2001 07/ 1 0/2002 07/23/2001
MONTICELLO
#4 INS CO MCL381158 07/10/1998 07/10/2001
MONTECELLO
#3 INS CO MCL362871 06/22/1996 06/22/1997
MONTICELLO
#2 INS CO TBD 08/25/1994 08/25/1995
TRAVELERS
#1 INS CO 660352K4025 08/25/1992 08/25/1994
.... '.....
Summons / Complaints Information
No Matching Information
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7/28/2005
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