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C1TY OF YEL~9 INSPECTION LOG
PROJECT- ~~ ~' (,P 22.t 1 >Z
PER'~11T'~L'~~9IIER p~ - p3s~
ADDRESS- l~-l X11 3 ~~ ~`' A ..0 S~
SET B.~C}~S Date:
Front Z~
Rear ~ D
Side Flar:~ine . (,~
S~~e
FOOTI'N'G `~'.~LL
~ ~ --~ b•,
l 6'• ~ g•,
other ~J other
.- -
required ti~ents ~•-
f OOTI~G REB.~R D41e: ~~'.aLL REB.aR
Date.
rnmmPntc
~~ t • ..... ~ •..V
CO~1B11ED FR~'~tEl EITERIOR ~}JE.~R "'.ALL l~~I'ECTI ~'
0.
Holy do~~~ns ~ ~he~r ~'ailir~ ~~
Fr~r~e ~ _,z- a~ _ "/~ ~ , Gas "Pre~~ne ...~~
Plur~~ine ~
` ~~ ~~i:chan~cal ~
~.
~~ w~C~ 1 ~--1 ~.
Cc~mmer,ts
l~Sl~L.aT)01 -~ ..
• ~ G~s = Elect~~c ~ Ot}~-er
'`-~ F03„ and deal ^ `'4} ~ r 1^ar; ier P~'.~
~-~~~.~C~,~, •~ ,~
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ommen-s
~I~EET ROC~'~~~E.aR `~'.~LL ~'.~1L
Comments
OTl{ER Ct~r~~m;r,~s
F 1 '.a L
' ~ Electrical
Se~~~er F.n;:) ~ Citi~il Find ~ Lan~sca~e Fin:~l ~ ~
~ _ C~f~
_ n.ul3tic~n ~ Site Drain~ce ~ ~i~e~~~~l~
Cc~n~n~ents c~,~j /~
FROM :YELM SEWER DEPT.
FAX N0. :360-458-8166 Jun. 09 2006 12:26PM P1
~~~ TNt p~
M .FAX TRANSMISSION
YBLM ~,n CITY OF YELM
P.O. BOX 479 - 931 NP ROAD NE
Y~LM, WA 98597
360-a58-8A1t
~~v~ FAX 360-458-8166
TO: (,Q l.I~,v DATE: 6-~-0~
FAX#:
PAGES: ~ , ~nclud~ng this
Cover sheet
From: ~i}Ndc~
Subject: ~~{SE /=1,/s}~-~d~K}{o,~,U ~~.
COMMENTS: ~ o r` ~, l'-l913 89~ Avg ~ S E
** If ou do ~a~ ~~ce~vc ~1~ ~~~~es or anY ~~PY i~ ~~~ ~~gible, ~I~as~ Cali ~3b0} 4~$-841 ~
as soon as pa~~i~~~,
NEW CpNSTRUCTION
HATER IIYSpECTIOIV
DATE: _(~~~~W
DEVELpp~NT:
~~-c~Q~
LoT # _~_~~x N~4 H
l.OtJ~ T ,S~•DEa,.a~K
1.OT# Htlyk
LOT#
~ Ci of Yelm
Community Development Department
a
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
IMAlMINGTON
Permit No: BLD-05-0359-YL
Issue Date: 10/2512005
(Work must be started within 180 days)
Receipt No: 38777
Applicant:
Name: Evergreen State Builders Phone: 253.475.6622
Address: P.0. Box 39753 City: Lakewood State: WA Zip 98499
Property Intorrnation;
Site Address: 14913 89th Ave. SE
Assessor Parcel No. 37540000600
Subdivision: Buckhorn Estates
Lot: 6
Contractor Information:
Name: Evergreen State Builders Contact: Medina, Ed Phone: 253-475-6622
Address: P.0. Box 197 City: Lakewood State: WA Zip: 98499
Contractor License No: EVERGS8980PB Expires: 10102106275 Business License:
Pro~;ct Information:
Project: Buckhorn Estates
Description of Work: 221112 SFR, Lot 6
Sq. Ft. per floor: (1st) 1071 (2nd) 1140 (3rd) 0 Garage 434 Basement 0
Heat Type (Electric, Gas, Other): GAS
Fees:
Item Item Fee Base Amt
Building Permit 100-500k 1,562.71 993.75
Building Plan Review 660.24 0.00
Mechanical Permit 78.25 0.00
Plumbing Permit 125.00 20.00
Sewer ERU 5,417.00 0.00
Sewer Inspection 145.00 0.00
Water ERU 1,500.00 0.00
Water Meter (SFD) 300.00 300.00
Water Deposit 40.00 40.00
Sewer Deposit 50.00 50.00
Traffic Facilities Charge 757.50 0.00
State Building Fee 4.50 4.50
TOTAL FEES: X10,640.20
Unit Fee Unit Rate No. Units Unit Desc
568.96 5.6000 101.6000 $1, 000
0.00 0.0000 0.0000
0.00 0.0000 0.0000
105.00 7.0000 15.0000 Fixture
5,417.00 5,417.0000 1.0000 ERU
145.00 145.0000 1.0000 ERU
1,500.00 1,500.0000 1.0000 ERU
0.00 0.0000 0.0000
o.oo o.oooo o.oooo
0.00 0.0000 0.0000
757.50 750.0000 1.0100 Peak PM Trip
0.00 0.0000 0.0000
Apptcant's ~4ffadavit:
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 ,~ ~F Date ,,~~~- ~ ~~"'`
Firm
OFFICIAL USE ONLY
Sets of Priors:
Final Inspection..
~~ D•6
i Date:
i
By' ~
i
YE 25589
LM COMMUNITY SCHOOLS
LOCAL RECEIPT DATE ~ d ' o~ ,~ #~ p~ D 0~ i
sub ~3- ~3<<~ <J1.. ~~~
Received from
FOR Y1r1 .~
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~ "~ OLLARS
ACCOUNTCODE AMOUNT
~~s CASH CHECK
o~a~, 19 ad a)
YE M COMMUNITY SCHOOLS
BY
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~~ Ci of Yelm Permi
ty t Fees Schedule
Community Development Department
Permit No; BLD-05-0359-YL
Building Division
Phone: (360) 458-8407
iNM1010N Fax: (360) 458-3144
ARplicant:
Name: Evergreen State Builders Phone: 253.475.6622
Address: P.O. Box 39753 City: Lakewood State: WA Zip 98499
Project ln~arma~ic~n:
Project: Buckhorn Estates
Description of Work: 221112 SFR, Lot 6
Site Address: 14913 89th Ave. SE Assessor Parcel No. 37540000600
Fes:
Item Acct Code Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
Building Permit 100-500k 032 001-322-10-00 1,562.71 993.75 568.96 5.6000 101.6000 $1,000
Building Plan Review 100 001-345-83-00 660.24 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 032 001-322-10-00 125.00 20.00 105.00 7.0000 15.0000 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 715 401-343-80-02 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
Sewer Deposit 742 402-389-01-00 50.00 50.00 0.00 0.0000 0.0000
Traffic Facilities Charge 420120-345-85-00 757.50 0.00 757.50 750.0000 1.0100 Peak PM Trip
State Building Fee 160 001-386-00-00 4.50 4.50 0.00 0.0000 0.0000
TOTAL FEES: 610,640.20
1~I~3/2Q05 11:21 _253283183 CAS PE5 3..'~F TDI~ PACE 05/
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sRF' 7141; a~f.E RESPON31A11,17Y t~~ THE CI.I~:NT.
CITY ~f YELM
-RESIDENTIAL BUILDING PERMIT APPL'~ TION FORM
Project Address:~l~ v~J~~ 1U~ ~,~ passel #:_ v~o?~~~,~
Subdivision: ,~~.~~Y~~~j Lot #:~_ Zoning; _~_E'~~~
~G~~~Z~~
New Construction u Re-Model J Re-Roof /Addition u Home Occupation Sign
u Plumbing U Mechanical U Mobile /Manufactured Home Placement u Other
Project DescriptionlScope of Work:_ ~~ijlG~ ~~ ~~~'+~. t.{ ~ ~ S-C G~L~ ~z~r Q.
Project Value:__~ ~,~ ~s(~ ~
Building Area {sq. ft} 1'~ Floor D 7/ 2nd Floor,~~/`7~D Garage ~~y peck
Bgsement Carport Patine/~
# Bedrooms # Bathrooms Z Heatin : GA THER or ELECTRIC (Circle One)
ARCHITECT/~NGINE
ADDRESS
CITY ~Ce ~i~n'7G
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STATE ~-C
SIP
GENERAL CGNTRACT(3R,~,„,~ ~ w ~ ,~'
ADDRESS
CITY _,STATEZIP
CONTRACTOR'S LICENSE # :~~ `~„
~iCENSE #
EMAIL
TELEPHONE
-~ ~~~
TELEPHCNE
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EMAIL
FAX
.~~.~~'P DATE~CITY LICENSE #
PLUMBING CC~NTRACTt~R ~. , ~ TE~.EPHONE~~~..~.3 ~~~
ADDRESS ~ ~- ~~ off- EMAIL
CITY%C.~ ., STATE C.~ ZIP~_FAX ~.~~ 5~ - 1~a
. ..~. _
CONTRACTOR'S LICENSE # _ ____-- -- EXP DATE~,CITY LICENSE # ___.._.
MECHANICAL ~ONTI~ACT R ~f`~~ TELEPHONE ~Z~~ ~~.~._.
ADDRESS ~ ~ /~ ~ EMAIL ~ ~ ~~ C?~r1~~S~.
CITY ~, ,STATE ~ ZIP ~'~~~r Z FAX ~~~ ~.~ ~' ~? -~ ~ -~ C~
CONTRACTOR'S LICI~NSE # EXP DATE _ CITY LICENSE # ' ~~~`~~
Copy cf mitigation agreement with Yelm Camrnunity Schools, if applicable.
# hereby certify that the above information is connect snd that the constructit~rtt on, and the occupancy and the use of the
above described property will be in accordance with the caws, rules and re~ulaUons of the State of Washington and the
City of Ye1m,
/ p--/4~-~vr~"
Applicant's 5ignatur~~ pad
t~wner 1 Contractor ! C?wnerls Agent !Contractor's Agent {please circle one.j
All permits are non-transferable and will expire if warts authorized by such perrnit is not begun
within 180 days of is:,uance, or `~ work is suspended or abandoned far a period of 164 days
I05 Yexm Auenue West (38U) 458r383~
P~ Box d 79 (36D) 45&3141 FAX
Yeim, WA 9859?' rvurr~.c:.yetm.rua.re~r
Are there any environrnentally sensitive areas located on the parcel? If yes, a
carnpleted environmer~tal checklist must accompany permit application.