20050425CITY OF YELM INSPECTION LOG
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FROM :YELM SEWER DEPT.
f q`'O~ 'RH'~ ~~
a M
Y'a~x..xv~c
WAaMINQTpN
FAX N0. :360-458-8166 Aug. 09 2006 08:45AM P1
~~~ '~RA.~SMISSION
CITY OF YELM.
P.O. ~3OX X79 - 931 NP ROAD NF
YELM, WA 98597
3 ~~-45 $-$4l 1
~~ AX -3 60-45 $-8166
TO: ~- ~,~, N~i~
FAx~:
From: ~~~~ ~
PAGES: 1 , includil~g this
Laver sheet
SubjecC: NaUS~ ~ iN,4L. $u C6ZI~.a(Z~V ~ 5'1`,
CO11i~NiFr1'~l'S: 1r v 1 1-31 ] y ~~ y gq~,~ ~ ~ c , Ste.
~:~
~~~~~~
~~
~~
* * if you d~ not receive ali copies; or any copy is ttot Ie~iblc, pleflse call (364} 458-841 1
as soon as possible.
NEW CONSTRUCTION
WATER INSPECTION
DATE: 8 '
DEVELOPMENT:
u.1il~.~r v v~r ~ ~-S`7-
LOT # ~__
LOT #
LOT #
Y i~q/` r
NEW CONSTRUCTION
WATER INSPECTION
DATE: ~~(~~
DEVELOPMENT:
B uc l-~~r~ Esi.
LOT # I ~
LOT #
LOT #
L.~LJI~ /~c7 /~-~
/`7 v'~7 '~L- 5~7 '70 /`/~~ ~
C~~z~, ~7~ - ~rvc ~,~r-~y5 0~`'
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: Evergreen State Builders
Address: P.O. Box 39753
Property Information:
Site Address: 14864 89th Ave. SE
Assessor Parcel No. 37540001300
Contractor Information:
Name: Evergreen State Builders
Address: P.O. Box 197
Contractor License No: EVERGS6980PB
Project Information:
Project: Buckhorn Estates
Description of Work: 2502S/2B SFR, Lot 13
Sq. Ft. per floor: (1st) 1034 (2nd) 1467
Heat Type (Electric, Gas, Other): GAS
Fees:
Permit No: BLD-05-0425-YL
Issue Date: 12/20/2005
(Work must be started within 180 days)
Receipt No: 39516
City: Lakewood
Subdivision: Buckhorn Estates
Contact: Medina, Ed
City: Lakewood
Expires: 10/02/06275
(3rd) 0 Garage 461
Basement 0
Item Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
---------------------------
Building Permit 100-500k -----------
1,676.95 -----------
993.75 -----------
683.20 -----------
5.6000 -----------
122.0000 -------------
$1,000
Building Plan Review 708.51 0.00 0.00 0.0000 0.0000
Mechanical Permit 78.25 0.00 0.00 0.0000 0.0000
Plumbing Permit 132.00 20.00 112.00 7.0000 16.0000 Fixture
Sewer ERU 5,417.00 0.00 5,417.00 5,417.0000 1.0000 ERU
Sewer Inspection 145.00 0.00 145.00 145.0000 1.0000 ERU
Water ERU 1,500.00 0.00 1,500.00 1,500.0000 1.0000 ERU
Water Meter (SFD) 300.00 300.00 0.00 0.0000 0.0000
Water Deposit 40.00 40.00 0.00 0.0000 0.0000
Traffic Facilities Charge 757.50 0.00 757.50 750.0000 1.0100 Peak PM Trip
Sewer Deposit 50.00 50.00 0.00 0.0000 0.0000
State Building Fee 4.50 4.50 0.00 0.0000 0.0000
Fire District Impact Fee 639.79 0.00 639.79 0.2160 2,962.0000 square foot
TOTAL FEES: $11,449.50
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 of record. If applying as a contractor, I futher certify that I am currently
registered in the State of Washington.
Signature -- Date~~i~e..~~
Firm ~~,6
Phone: 253.475.6622
State: WA Zip 98499
Lot: 13
Phone: 253-475-6622
State: WA Zip: 98499
Business License:
# Sets of Prints:
Final. Inspection:
Date: ~ //~ s
gy; ~augd
a~~F T"Epp CITY OF
m YELM
P.O. Box 479
Yelm, WA 98597
SL 360-458-8403
RECEIVED
****ELEVEN THOUSAND FOUR HUNDRED FORTY` NINE DOLLARS
RECEIVED FROM D~fE REC. NO.
EVERGREEN STATE BUILDERS 12/20/05 39516
PO BO% 39753
LAKEWOOD. WA 98499 BUDGETARY
BLD-05-0425-YL
SITE: 14864 89TH AVE SE
CEIPT o. 9 516
& 50 CENTS
AMOUNT REF. NO.
11.449.50 CHECK PENDING
BLDPRMT1676.95. PLNREV708.51, MECHPRMT78.25. PLMB132. S/ERU5417. S/INSP145
W/ERU1500, W/HTR300. W/DEP40. TRAFF757.50. S/DEP50. STFEE4.50. FIRE639.79
o~~f T"Ep'o~C CITY OF
4 m YELM
YePm0, WA 98597 RECEIPT No. 3 9 517
EL 360-458-8403
RECEIVED
****ELEVEN THOUSAND ONE HUNDRED SI%TY FIVE DOLLARS & 81 CENTS
RECEIVED FROM DATE REC. NO. AMOUNT REF. NO.
EVERGREEN STATE BUILDERS 12/20/05 39517 11.165.81 CHECK PENDING
PO BOB 39753
LAKEWOOD. WA 98499 BUDGETARY
BLD-05-0423-YL
SITE: 14858 89TH AVE SE
BLDPRMT1539.75. PLNREV650.54. MECHPRMT78.25. PLMB118, S/ERU5417. S/INSP145
W/ERU1500. W/MTR300. W/DEP40. S/DEP50. TRAFF757.50, STFEE4.50. FIRE565.27
YELM COMMUNITY SCHOOLS v 2 5 5 9 7
LOCAL RECEIPT DATE ~ a -- ~ g--
Received from ~fJL~C.,(~(,LQi„_.- ~a,~, QJ~~Qr, ,
~`- /~ V
FOR ' { v ~ ~~ ~°~ ~ 1 Z i ~ ~ ~ ~ ~ L
-~C. ~~-ewc~ ~ L~"t~-,...C-~a+~ `~~ ~~ .r DOLLARS
ACCOUNT CODE AMOUNT CASH CHECK Jv S'Q y
~ ~ ~:
$lo ~- ~ v
YELM COMMCNITY SCHOOLS
By ~~~
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360)458-3144
Permit Fees Schedule
Permit No: BLD-05-0425-YL
Applicant:
Name: Evergreen State Builders Phone: 253.475.6622
Address: P.O. Box 39753 City: Lakewood State: WA Zip 98499
Project Information:
Project: Buckhorn Estates
Description of Work: 2502S/2B SFR, Lot 13
Site Address: 14884 89th Ave. SE Assessor Parcel No. 37540001300
Fees:
Item
---- Acct Code
------------- Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
Building Permit 100-500k
032 001-322-10-00 ---------
1,676.95 ----------
993.75 ---------
683.20 -----------
5.6000 -----------
122.0000 -------------
$1,000
Building Plan Review 100 001-345-83-00 708.51 0.00 0.00 0.0000 0.0000
Mechanical Permit 032 001-322-10-00 78.25 0.00 0.00 0.0000 0.0000
Plumbing Permit 032 001-322-10-00 132.00 20.00 112.00 7.0000 16.0000 Fixture
Sewer ERU 802 412-343-50-01 5,417.00 0.00 5,417.00 5,417.0000 1.0000 ERU
Sewer Inspection 805 412-343-80-00 145.00 0.00 145.00 145.0000 1.0000 ERU
Water ERU 715401-343-80-02 1,500.00 0.00 1,500.00 1,500.0000 1.0000 ERU
Water Meter (SFD) 712 401-343-80-01 300.00 300.00 0.00 0.0000 0.0000
Water Deposit 740 402-389-00-00 40.00 40.00 0.00 0.0000 0.0000
Traffic Facilities Charge 420 120-345-85-00 757.50 0.00 757.50 750.0000 1.0100 Peak PM Trip
Sewer Deposit 742 402-389-01-00 50.00 50.00 0.00 0.0000 0.0000
State Building Fee 160 001-386-00-00 4.50 4.50 0.00 0.0000 0.0000
Fire District Impact Fee 105 001-345-85-00 639.79 0.00 639.79 0.2160 2 ,962.0000 square foot
TOTAL FEES: $11,449.50
12/15/2005 15:32 2532843183 CAS RE5 NWAF ~M PAGE 05
~e~rnAVn~~sou~sr F~~~elVed
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vC~4l.E 1" = 2P~'
THIS DRAWING IG BASED DN Cl7F,Ni-PRbYIDEb INFORMATION R6vREGENtE6 to 8E AOCURAT[
AND "F.41ADL[, ANY ble^CREPANCIf$ RETWF.EN THIS DRAWING AND TNC. ACTUAL SRE CONDIi1QNG
ARE THE SOLE DRSROfN'fBILITV OF THC CI IPNY
CITY OF YELM
B~SIDENTIAL BUILDING PERMIT APPLIC, 1N FORM
Project Address:~,~`Qm~,_~` ~7~ ~~,~¢ ~~ ~~ #: ~~"a Z • Z.
Sub~division:~~~'0? S Lot #:_ / 3 Zoning; Ccl-~ ~
L}'CVew Construction ~~~~2~~
U Re-Model / Re-Roof /Addition u Home Occupation Sign
U Plumbing u Mechanical u Mobile /Manufactured Home Placement u Other
Project DescriptioNScope of Work:_ ~~ (~% -~Cf,Drz~~ mss.-~r-c~.~'~c~'lc~
Project Value: ~7 7 ~'`, ~,$~
Building Area {sq. ft} 1°1 Floor/a 3 2"~ Floor/_~z Garage ~~/ Deck~~
Basement Carport Patio_ 2,/~
# Bedrooms, # Bathrooms 3 Heati •• AGES/ THER or ELECTRIC (Circle One)
Are there any environrnentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: ~' ~
ADDRESS - EMAIL ~ i Pcz~~~¢, rt:„p~
CITY STATE(.' ZIP Yq9 TELEPHONEGzs3~ ~7~ -~ ~vZ Zr
ARCHITECT~ NGINEER SC'~t ICENSE #
ADDRESS /per ~~ EMAIL
CITY'7~~ ~_STATE c~ZIP O TELEPHONE ~ZS3~»'L/- ~/-~~
GENERAL CONTRACTOR SCL~p~ ~ p[-c~c-Q-r~ TELEPHONE
ADDRESS EMAIL
CITY _STATE ZIP FAX
CONTRACTOR'S LICENSE # E~(/ '(? ~ _ EXP DATE D7 CITY LICENSE #
PLUMBING CONTRACTOR .S~c~? IkQ ELEPHONE_~z5~~ .-~~'7- ~jy(~
ADDRESS /`~Sf~ ~ _EMAIL
CITY ~GCrJJ~°Yl !~. _STATE ~ ZIP S~ ~ FAX.. L~g~37 ~ (D~' ~!
CONTRACTOR'S LICEENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR G~'`ff~ '~ TELEPHONE CZ.s`~~~-~Q
ADDRESS S ~...~~- ---- _ EMAIL
CITY P _STATE G~./-I ZIP~FAX
CONT CTOR' LICIE.NSE # EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable.
1 hereby certify that tfie above information is correct and that the construction on, and the occupancy and the use of the
above described property will be in accordance wNh the laws, rules and regulations of the State of Wasfiington and the
City of Yetm.
Applicant's Signatures Date
Owner / Contractor l Owner's Agent 1 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 is:yuance, or if work is suspended or abandoned for a period of 1St? days
I05 Yetm AvenueWeet (360j 458-3835
PD Box 479 (3B0) 468-314 FA%
Yetm, WA 98597 mmm.ei.yelm.wa.ua