BLD-05-0087
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0087 - YL
Issue Date 03/30/2005
(Work must be started within 180 days)
Receipt No
36011
Applicant:
Name: Lester Caldwell
Phone.
458-1565
Address. 1502 Yelm Ave West, #9
City' Yelm
State. WA Zip 98597
Property Information:
Site Address. 1502 Yelm Ave. West
Assessor Parcel No. 21713340404
Subdivision: Sunrise Vista
Lot: 9
Contractor Information:
Name: DB&R
Contact:
Phone: 360-269-3877
Address. 316 Jackson S1.
City' Centralia
State: WA Zip 98531
Contractor License No. DBRIN**044JQ
Expires. 04/10/06100
Business License: 846.0
Projectlnformation:
Project: Sunrise Vista
Description of Work: 41x66 Mfg. Home
Sq. Ft. per floor' (1 st) 0
Heat Type (Electric, Gas, Other).
(2nd) 0
(3rd) 0
Garage 0
Basement 0
Fees:
Item
Item Fee
Base Amt
Unit Fee
Unit Rate
No. Units Unit Desc
Building Permit - Other
TOTAL FEES.
150 00
$150.00
0.00
000
o 0000
00000 $1 000
Applicant's. Affadavit:
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 d. If applying as a contractor I futher certify that I am currently
register Son.
OFFICIAL USE ONLY
# Sets of Prints.
Date
..o.s-
Final Inspection:
-1
Date: sAt) /p(
r / ~
By' ~
Firm
Applicant:
Name. Lester Caldwell
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit Fees Schedule
Permit No BLD-05-0087-YL
Phone:
458-1565
Address 1502 Yelm Ave West, #9
State. WA Zip 98597
Project Information
Project: Sunrise Vista
City' Yelm
Description of Work: 41x66 Mfg. Home
Assessor Parcel No 21713340404
Site Address 1502 Yelm Ave. West
Fees
Item
Building Permit - Other
Acct Code
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
032001-322-10-00
150 00
000
000
o 0000
00000 $1 000
TOTAL FEES
$150.00
G
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_._ ....._._.__ '_0'- _____. .
RECEIPT No 36011
****ONE HUNDRED FIFTY DOLLARS & 00 CENTS
RECEIVED FROM
LESTER CALD\'JELL
1502 YELM AVE W #9
YELH, l;lA 98597
SITE: 1502 YELM AVE W
BLDG PRHT 150 00
REF NO
DATE REG NO
03/30/05 36011
AMOUNT
150.00 CHECK
7222
MISCELLANEOUS RECEIPT
MICHELLE
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AUG-14-2003 07 28
Ye1m COO
360 458 3144
P 03
CITY OF veLM
RESIDENTIAL BUILDING PERMfT APPLICATiON FORM
Project Address: / SO)' _If/In ~ tJl.::C: Parcel #: .11 r J3JI/6<Ial
Subdivision: Lot #: 9 Zoning;
Received
MAR 1 5 2005
U New Construction U Re-Model ( Re-Roof I Addition U Home Occupation Sign
u Plumbing U Mechanical u--M"'obile I Manufactured Home Placement U Other
Project Description/Scope of Work: J;'lIol; LeI V>1 <// ~ /p/? nrobf J ('
project Value: / ~: aX.>
Building Area (sq. 1\) 1st Floor V- 2m! Floor Garage Deck
Basement CarPort Patio i
# Bedrooms ~ # Bathrooms.2, Heating: GASlOTHERio~Circle One)
Are there any environmentally sensitive areas located on the parrel? If yes, a
completed environmental checklist must accompany permit applicatIon.:
EMAlL
TELEPHONE I
ZIP
LICENSE # :
EMAIL '
TELEPHONe 1
ARCHITECTIENGINEER
ADDRESS
CITY STATE
CI1
tt/t,.1J
1ELEPHONE~,
EMAIL
FAX
EXP DATE CITY LICENSE #
TE:lEPHONEj
EMAIL
FAX
EXP DATE_CITY 1..ICENSE #
PWMBING CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
ZIP
MECHANICAl CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
ZIP
Copy of mitigation agreement with Velm Community Schools, if applicable.
I ....trr Cl8rtify \hut the above Information Is cornlCt III1d that the eonslnletlan Oft. Dnd tIJe OCCuplll1CY and the us. of 1Iwt
above deKrt~ pmpMty wiD IIIe In 8CClOrd8nGe wltJl the laws, nile. Bnd rvgulatJona of tile Stilt. of Washington .nd tf1e
City of Vel
AU permits 8f8 non-transferable and wUI expire if work authorized "1 such permit 1$ not begun
within 180 days of Issuance. or if work is suspended or abandon.. for a period of 180 days
($60) 451-3835
(360) 458-3144 FAX
wWUl.t:I.)'elm,w/I.N8
tD& V.lm Avanue WAf
PO BMt 4'/9
V.lm, WA 9aS91
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A business registered as a construction contractor with L8:1 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 DBRIN**044JQ
:1 Licensee Name D B 8: R INC
Licensee Type CONSTRUCTION CONTRACTOR
UBI 601692387 VerifY' Workers Comp Premium
Status
Ind. Ins. Account
Id
Business Type CORPORATION
Address 1 316 JACKSON ST
1 Address 2
City CENTRALlA
County LEWIS
State WA
Zip 98531
Phone 3607368542
Status ACTIVE
Specialty 1 GENERAL
Specialty 2 UNUSED
Effective Date 4/18/1996
Expiration Date 4/10/2006
Suspend Date
Separation Date
Parent Company I
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Business Owner Information
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Name Role Effective Date Expiration Date
YOUNG, DAVID B
01/01/1980
Bond Information
,
Bond Bond
Company Account Effective Expiration Cancel Impaired Bond Received
Bond Name Number Date Date Date Date Amount Date
AMERICAN
CONTRACTORS Until
#4 INDEMINIT 210244 04/10/2004 Cancelled $12,00000 04/09/2004
Until
#3 CB1C SA2369 03/11/2002 Cancelled 04/10/2004 $12,000 00 03/11/2002
#2 CBIC SA2369 04/10/1998 03/11/2002 $6,000 00
#1 CBIC SA2369 04/10/1996 04/10/1998 $6,000 00
, ...,....,
Savings Information
No Matching Information
Insurance Information
'. Company Effective Expiration Cancel Impaired Receive
, Insurance Name Policy Number Date Date Date Date Amount Date
CLARENDON
AMERICA GNW46-
#5 INS CO 0060000496 10/01/2004 10/01/2005 $1,000,000 00 01/17/20
OHIO CAS
#4 INS CO BHO 53046556 01/13/2004 01/13/2005 $500,00000 01/12/20
OHIO
CASUALTY
INS
#3 COMPANY BHOQQOO029420 01/13/2003 01/13/2004 $500,000 00 01/24/20
ZURICH INS
#2 CO Q78069704 01/30/2002 01/30/2003 03/11/20
#1 CBIC INSSA2369 04/10/1996 04/10/2002 01/28/2002 04/16/20
, '", '"
Summons / Complaints Information
Tax
Summons / Cause Warrant Dismissal Complaint Complaint Judgement JudgemE
Complaint Number Id Plaintiff County Date Date Amount Date Amoun
SUZANNE
D
#3 052002538 SWANSON THURSTON 02107/2005 $000 $000
NATL
ASSOC OF
CREDIT
#2 042000432 MNGT KING 05/10/2004 01/08/2004 $2,220 46 $000
BAKER,
RICHARD
#1 032014441 & NORA LEWIS 11/24/2003 $000 $000
..""... ,
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