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FROM :YELM SEWER DEPT.
4~4~ 'tM~ A,s
4 ~_ ~
' FAX N0. :360-458-E3166 Sep. 07 2006 11:59AM P1
~A~ ~'RANS~VIIS~ION
CITY OF YELM
P.C?. BOX 479 -~ 931 NP ROAD NE
YELaV1, WA 9$597
3b0-458-5411
FAX ~3b0~458TS a b6
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To: ~ ~ t-~- iT~ ~, ~
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Fram: ~nNiJ~
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PAGES: f ,including this
- Dover sheet
Subject: 1-I~,~S~ ~~~N~lt-- ~3u~~~« ~~a(~ ~~'C
C;OMIVIENTS: ~ a j ) ~ ~ 1 ~-) ~ ~~ `~?~ I-}v ~ ~ ~. ~
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** lfynu do not c~eceivc al{ copies or any copy i~ not ie~iblc, please call (360) 45$-R41
as sootl as possible.
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 Informallon:
Site Address: 14858 89th Ave. SE
Assessor Parcel No. 37540001200
Contractor Information:
Name: Evergreen State Builders
Address: P.O. Box 197
Contractor License No: EVERGSB980P6
Project Information:
Project: Buckhorn Estates
Description of Work: 2161/2 SFR, Lot 12
Sq. Ft. perfloor: (1st) 973 (2nd) 1188
Heat Type (Electric, Gas, Other): GAS
Fees:
City: Lakewood
Subdivision: Buckhorn Estates
Contact: Medina, Ed
City: Lakewood
Expires: 10102/06275
Phone: 253.475.8622
State: WA Zip 98499
Lot: 12
Phone: 253-475-6622
State: WA Zip: 98499
Business License:
(3rd) 0 Garage 426 Basement 0
Item Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
---------------------------
Building Permit 100-500k -----------
1,539.75 -----------
993.75 -----------
546.00 -----------
5.6000 -----------
97.5000 -------------
$1,000
Building Plan Review 650.54 0.00 0.00 0.0000 0.0000
Mechanical Permit 78.25 0.00 0.00 0.0000 0.0000
Plumbing Permit 118.00 20.00 98.00 7.0000 14.0000 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
Sewer Deposit 50.00 50.00 0.00 0.0000 0.0000
Traffic Facilities Charge 757.50 0.00 757.50 750.0000 1.0100 Peak PM Trip
State Building Fee 4.50 4.50 0.00 0.0000 0.0000
Fire District Impact Fee 565.27 0.00 565.27 0.2160 2,617.0000 square foot
TOTAL FEES: $11,165.81
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.
Signatur~~/~~// Date ~~ !~~
Fir ~Ir' s~ „
Permit No: BLD-05-0423-YL
Issue Date: 12/20/2005
(Work must be started within 180 days)
Receipt No: 39517
Y
# Sets of Prints:
FinaF lnspec "on:
Date:
B:
o~~f T"Epp CITY OF
a ~, YELM
P.O. Box 479
Yelm, wA x8597 RECEIPT No. 3 9 51'6
z 360-458-8403
RECEIVED
****ELEVEN THOUSAND FOUR HUNDRED FORTY NINE DOLLARS & 50 CENTS
RECEIVED FROM DATE REC. NO. AMOUNT REF. NO.
EVERGREEN STATE BUILDERS 12/20/05 39516 11,449.50 CHECK PENDING
PO BO% 39753
LAKEWOOD. WA 98499 BUDGETARY
BLD-05-0425-YL
SITE: 14864 89TH AVE SE
BLDPRMT1676.95, PLNREV708.51, MECHPRMT78.25, PLMB132, S/ERU5417. S/INSP145
W/ERU1500, W/MTR300, W/DEP40, TRAFF757.50. S/DEP50, STFEE4.50, FIRE639.79
o~~f THEp~9 CITY OF
YELM
YePmO, WA 98597 RECEIPT No. 3 9 517
mss. 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 BO% 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 v2 5 5 9 7
LOCAL RECEIPT DATE a~ - ~ g--
Received from
FOR
Z) /3. /~f ~..
` "'~ -" DOLLARS
ACCOUNT CODE AMOUNT CASH CHECK Jt,~~~Q `f
YELM COMMUNITY SCHOOLS
By ~~
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
Project Information:
Project: Buckhorn Estates
Description of Work: 2161/2 SFR, Lot 12
Site Address: 14858 89th Ave. SE
Fees:
Item Acct Code
--------------------------
Building Permit 100-500k --------------
032 001-322-10-00
Building Plan Review 100 001-345-83-00
Mechanical Permit 032 001-322-10-00
Plumbing Permit 032 001-322-10-00
Sewer ERU 802 412-343-50-01
Sewer Inspection 805 412-343-80-00
Water ERU 715 401-343-80-02
Water Meter (SFD) 712 401-343-80-01
Water Deposit 740 402-389-00-00
Sewer Deposit 742 402-389-01-00
Traffic Facilities Charge 420 120-345-85-00
State Building Fee 160 001-386-00-00
Fire District Impact Fee 105 001-345-85-00
TOTAL FEES:
City: Lakewood
Permit Fees Schedule
Permit No: BLD-05-0423-YL
Phone: 253.475.6622
State: WA Zip 98499
Assessor Parcel No. 37540001200
Item Fee
-------- Base Amt Unit Fee Unit Rate No. Units Unit Desc
1,539.75 -----------
993.75 ----------
546.00 -----------
5.6000 -----------
97.5000 -------------
$1,000
650.54 0.00 0.00 0.0000 0.0000
78.25 0.00 0.00 0.0000 0.0000
118.00 20.00 98.00 7.0000 14.0000 Fixture
5,417.00 0.00 5,417.00 5,417.0000 1.0000 ERU
145.00 0.00 145.00 145.0000 1.0000 ERU
1,500.00 0.00 1,500.00 1,500.0000 1.0000 ERU
300.00 300.00 0.00 0.0000 0.0000
40.00 40.00 0.00 0.0000 0.0000
50.00 50.00 0.00 0.0000 0.0000
757.50 0.00 757.50 750.0000 1.0100 Peak PM Trip
4.50 4.50 0.00 0.0000 0.0000
565.27 0.00 565.27 0.2160 2,617.0000 square foot
$11,165.81
12!15!2@@5 15:32 2532843183 CAS RES NWAF..ZDM PAGE @5
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o 'IC'ON COUNTY, TiP,A, DEC 1 ~; ?_ 0 0 5
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SITE PLAN„ APPROVAL.
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~ 2D05 CASCADE RESIDENTIAL DESIGN, INC. 5G>4~E ~r e ~fa~
THIS ORAWINC ("w' BASED ON CIJFNT-ppHVIpED INFORMATION RipRE~'fNTED To rE ArruRATH
ANG AF.LWN,F„ ANY EIISCREPANCIF^ a[twEfN iH1S ORAM7Nl: AND THE ACTilAL SRF CMIOITIONS
ARE THE Ri}I,E RESpbN51rlI.ITY ffT T1lF. CLIENT,
e•o-~a
CITY OF YELM
~SIDENTIAL BUILDING PERMIT APPLtC ON FORM
Project Address: /,~~, ~ ~=~~v~ ~ ~j /_ Z
#: 6
Subdivision:~J~'/? S Lot #:~~ Zoning; ~-.~cf-~ ~
LYNew Construction ~~~Y~
U Re-Model / Re-Roof !Addition U Home Occupation Sign
U Plumbing U Mechanical U Mobile / Manuf'actu~red Home Place~m~ent~ U Other
Project DescriptioNScope of Work: SPiyLI'-~~~~~..~~cc--v--~1 ,~Q~~~~t.~e--~
Project Value: '~ Z~~ ~~a I
Building Area {sq. ft) 1°~ F1oor ~73 2"~ Flood'/~a Garage ~z6 Deck
Basement Carport ~~y Patio .Z /6
# Bedrooms„'r~' # Bathrooms~,,s Heating:~GASfOTHER 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: QI' ~
ADDRESS - EMAIL _~'~/i pg~~s,~,,~~
CITY_LGt,,E'p1,,c,c,Y~~v _STATE( ZIP ~'9 TELEPHONEGZ.s3~'1',L7S--~~aZ~
ARCHITECT NGINEER S~'~ ~ ICENSE #
ADDRESS C~o~i ~o p~ EMAIL
CITY'7~~_STATE i~ZIP~TELEPHONE, C`ZS~y,~ 7 ~'L/- ~/-7n
GENERAL CONTRACTOR SC.n;~ oli c fpC-~~ ~' TELEPHONE
ADDRESS EMAIL
CITY _STATE ZIP FAX
CONTRACTOR'S LICENSE # ei ~,v_~~EXP DATE p7 CITY LICENSE #
PLUMBING CONTRACTOR ,.S~x,~'I /~t_Q ELEPHONE_Cz~~7 .~3`/- I~CC~
ADDRESS_/'~/~ EMAIL
CITY %Gt?L•',y~v?,~. STATE c[~ ZIP ~` FAX C~~~37 ..3~~ ~,
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTIZ4CTOR G~' '< TELEPHONE CZS~~ ~
ADDRESS S ~...~~- -- EMAIL '
CITY ~ _STATE L.~C~"1 ZIP &~3~ FAX
CONT CTOR' UCIcNSE # EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable.
t 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 Ye1m.
Applicant's SignaturB
Owner tContractor /Owner's Agent /Contractor's Agent
Date
(Please circle one.}
Alt permits are non•ti•ansferable and will expire if work authorized by such permit is not begun
within 180 days of is:~uance, or if work is suspended or abandoned for a period of 1St? days
IU5 Yelm AvenueWeat
PO Box 479 (3G0) 45&3835
Yelm, WA 98597 (360) 468-3144 FAX
www.ei.yelm.wa.eea