BLD-05-0208
~C". ~.. · ...~"'~'...~
I~ ~.~I
~
City ofYelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0208- YL
Issue Date 07/11/2005
(Work must be started within 180 days)
Receipt No
37240
Applicant:
Name: Eatonville Roofing
Phone:
253-686-1645
Address. 34767 39th Ave. Ct. E
City' Eatonville
State: WA Zip 98383
Property Information:
Site Address. 15425 Mosman
Assessor Parcel No 21724440200
Subdivision.
Lot:
Contractor Information:
Name: Applicant
Contact:
Phone:
Address
City'
State.
Zip.
Contractor License No.
Expires.
Business License.
Project Inf()l1Tl~t.ion:
Project: Nisqually Valley Golf Course Tractor Garage
Description of Work: Reroof
Sq. Ft. per floor' (1st) 0
(2nd) 0
(3rd) 0
Garage 0
Basement 0
Heat Type (Electric, Gas, Other): OTHER
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
--------------------------- -------------
Building Permit - Other 25.00 000 0.00 o 0000 o 0000 $1 000
TOTAL FEES. $25.00
Appli~~l1t.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 restrictions of record. If applying as a contractor I futher certify that I am currently
registered in the State of Washington.
Signature ~7~ . Date 7-//-1115
F. ,-
Irm
# Sets of Prints.
Finall!!:>p_ection: .._._'
D<1;,;.. ~J \~~ O~.~
By' G~fU
\
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit Fees Schedule
Permit No BLD-05-0208-YL
Applicant:
Name: Eatonville Roofing
Phone'
253-686-1645
Address. 34767 39th Ave. Ct. E
City' Eatonville
State. WA Zip 98383
Project Information
Project: Nisqually Valley Golf Course Tractor Garage
Description of Work: Reroof
Site Address 15425 Mosman
Assessor Parcel No. 21724440200
Fees:
Item
Acct Code
Item Fee Base Amt Unit Fee
Unit Rate No Units Unit Desc
Building Permit - Other
032 001-322-1 0-00
2500
000
000
o 0000
00000 $1 000
TOTAL FEES
$25.00
. '
; ,
.. .'.:~;:FIII!.~.~~:,
RECEIPT No 37240
RECEIVED
**-*TWENTY rIVE DOLLARS & 00 CENTS
RECEiVED FROM
EATCNVILLE ROOFING
34767 39TH 39TH AVE CT E
EATONVILLE WA 93383
DATE REC. NO
07111/(35 37240
AMOUNT
25 ()O CHEer-
REF NO
1933
BUDGETARY
SItE
1542: HO:3!'lAN
',,---
oLU 1:',111'
[ Il\NA
c
c
c
CITY OF YELM
COMMERCIAL BUILDING PERMIT APPLICATION FORM
Project Address: IS- 92 -r /11 () ;'/J1 J).Jv .s-.w yeC"Parcel #" .2, 72.. ~Yl./ t:> ~o
Zoning; ble:; Current Use Proposed Use
I
U New Construction D--Re-Model/ Re-Roof / Tenant Improvement
U Plumbing U Mechanical U Fire PrevenVSuppress/Alarm
U Other
Project Description/Scope of Work: ~ .%,r
Project Value: ). J 2.}'. {' Y
~r;i~
Building Area (sq ft) Parking Garage
Building Height I ..>/OfiR'y
1 sf Floor
2nd Floor
3rd Floor_
Are there any environmentally sensitive areas located on the parcel?
completed environmental checklist must accompany permit application
If yes, a
BUILDING OWNERffENANT NAME. Jr /)- r~A!l y v,A-//e//
ADDRESS / 5" ~ :2- S /IYJ r'l )' /I1~)V . EMAIL /
CITY J/~~)IA STATE wI} ZIP r?FP 1 TELEPHONE
"
ARCHITECTIENGINEER
ADDRESS
I "'''T'''-'
I v, I ,
LICENSE #
EMAIL
T=L=P!-!U~!=
C'TATC
\Jlr\'~
z~p
GENERAL CONTRACTORE /)fClI/fI//e A'6a.0/Pp TELEPHONE )JJ1 (9(
ADDRESS 1 f/'7 6 7 ? f /.).Ir C T - EMAIL . ~
CITYF~J2I1lr vU/F STATE]v}.~ ZIP 9f1J.2Y FAX ..
CONTRACTOR'S LICENSE # F i+r~ IV /{ KrYlf'~ DA T~6'cITY LICENSE #
J(,(/~
PLUMBING CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
ZIP
MECHANICAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
ZIP
Copy of City Mitigation documentation (TFC).
I hereby certify that the above Information Is correct and that the construction on, and the occupancy and the use of the
above described property will be In accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
~~
.di$pli nt's Signature
Owner / Contractor / Owner's Agent / Contractor's Agent / Tenant
7- 7- O?
Date
(Please circle one)
All permits are non-transferable and will expire if work authorized by such permit is not begun
withi n 180 days of issuance, or if work is suspended or abandoned for a period of 180 days
105 Yelm Avenue West
PO Re% 479
Yelm, WA 98597
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wa.us
c
c
c
CITY OF YELM
REQUIREMENTS FOR COMMERCIAL PLANS SUBMITTAL
Cover Sheet Must Include the Following:
Address of Building
Owner of Building and Phone Number
Architect and Phone Number
Contractor and Phone Number
Building Use
Legal Description
Zone
Code (Seismic, Wind, Snow, Live Load and Dead Load)
Occupancy Group
Construction Type
Building Area
Plans Must Also Include the Following:
Five (5) Full Sets of 24" x 36" Plans - one of these may be a ~-scale set - which
include
Prints must be drawn and stamped by an Engineer or Architect*
Foundation plan and details
Structural plan and details
Area separation walls/Rated corridor details
Elevations
Number of stories
Building height
Roof drainage
Mechanical drawings
Electrical drawings
Plumbing drawings
Exits
Fire alarm or sprinkler systems, if required
NRED (Non Residential Energy Code)
Two (2) Sets of Specifications
* With the approval of the Building Official, small non-structural projects need not
have a stamp
105 Yelm Avenue West
PO Box 479
Ye1m. WA 98597
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wa.us
Look Up a Contractor, Electnclan or Plumber LIcense Detml
Page 1 of2
Topic Index I Contact Info
v..-._-.....~'r........... .................----....-'V.........-...........---..............................'V'-~_..-_...,.~--,
Safety Claims & Insurance Workplace Rights 'Trades & licensing ,
! Find a Law or Rule I j Get a Form or Publication I
------'..-."'-_._"",.;.--.,."'_--.-----,""',""""""'-~""""'--,.~,..,.~- "'...._~...."'^""....'""---"""'~,~_."'-,...,....,~.._..
Look Up a Contractor, Electrician or Plumber
r---" "'..."-.----""-""""~"..&,,.,.,""~'"'--, ^-'."'=",-'""....'..,."""~,."'---""','=,'>.'-..".'.,..._.'_.'_. ""'..,~',-~ "",,"
I General/Specialty Contractor
IA business registered as a construction contractor with Uti to perform construction work within the scope
iof its specialty A General or Specialty construction Contractor must maintain a surety bond or assignment
lof account and carry general liability insurance
~---,,---_._--~..~._---_....,-_.............__....-.._......_-,-
,I
License Information
License EA TONR*009MU
Licensee Name EATONVILLE ROOFING
Licensee Type CONSTRUCTION CONTRACTOR
UBI 602055527 Verify Workers Comp Premium
StatJ.J2
Ind. Ins. Account
Id
Business Type INDIVIDUAL
Address 1 34707 39TH AVE CT E
Address 2
City EATONVILLE
County PIERCE
State WA
Zip 98328
Phone 2538463156
Status ACTIVE
Specialty 1 GENERAL
Specialty 2 UNUSED
Effective Date 7/31/2000
Expiration Date 8/8/2006
Suspend Date
Separation Date
Parent Company
Previous License PERKIRI053CN
Next License
Associated
License
........--,- --_......'<~""''''-....._.,'-..,~ ~"".-
,----
! Business Owner Information
i I I
-_."'._~'"'~-----'-------;;
il
I:
https.//fortress.wa.gov/lm/bblp/Detall.aspx?Llcense=EA TONR *009MU
7/812005
Look Up a Contractor, ElectncIan or Plumber LIcense Detail
Page 2 of2
Name
Role
Effective Date Expiration Date
GERALD OWNER 01101/1980
~-'~--_...,-'~'~~---". -"--"'._.~~-"---~,~-,,
, Bond Information
I Bond Bond
Company Account Effective Expiration Cancel Impaired Bond Received
~Bond Name Number Date Date Date Date Amount Date
I Until
1#3 CBIC SD1434 07/31/2001 Cancelled $12,00000 08/08/2001
1#2 CBIC SD1434 04/26/2001 07/31/2001 $6,000 00 04/26/2001
i Until
1#1 . CBIC~~._~_~~~~~ 0~~2!3000 Cancelled 06/23/2001 $4,00000 05/10/2001
i---~'--'--'._-'
i Savings Information
L___...._~,....~~~~~.~!5_~~~~~!O!~~,~~~._,=~._.__._~. ._. J
III11UI all~~ Information
Company Effective Expiration Cancel Impaired Received
Il1surance Name Policy Number Date Date Date Date Amount Date
NATIONAL
FIRE &
MARINE INS
#6 CO 72LPE345438 08/05/2004 08/05/2005 $1,000,000 00 08/05/2004
NORTHFIELD
#5 INS CO CP7771489 07/31/2003 07/31/2004 $500,00000 07/30/2003
RED SHIELD
#4 INS CO CNT010879 07/31/2002 07/31 /2003 $500,000 00 09/23/2002
RED SHIELD
#3 INS CO CNT3379912 08/01/2002 08/01/2003 07/23/2002
OREGON
MUTUAL INS
#2 CO SLWS709010668 07/31/2001 07/31/2002 07/19/2001
OREGON
#1 MUTUAL INS TBD 07/31/2000 07/31/2001
r::-----.-~_._.-'-'-~.,.--.~---..--.----.-~-..,-.--~.-., -. ..-..,
I Summons / Complaints Information i
L .__,_____~~ M~.~~~~~.!.~for~~io~_.,_ Ii
Start a New Search Printer Friendly Version
About Lal I Find a job at Lal I Informacion en espanal I Site Feedback I
1-800-547-8367
Washmgton State Dept. of Labor and Industries. Use of this site is subject to the laws of the
state of Washington
Access Agreement I Privacy and security statement I Intended use/external content policy I Visit access.wa.gov
Staff only link
https./ /fortress.wa.gov/lm/bbIp/Detall.aspx?LIcense=EA TONR *009MU 7/8/2005