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FROM :YELM SEWER DEPT.
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FAX N0. :360-458-8166 May. 12 2006 84:03PM P1
F.AX TRANSMISSION
CITY OF YELM
P.O. BOJ{ 479 - 931 NP ROAD NE
YELM, WA 98597
~ , 360-458-8411
C ~(Z~ FAX 360-458-8166
~,
TO: G-12E~NEn) DATE: 5-Ja o6
FAX#: PAGES: 1 ,including this
Cover sheet
From: ~l~,uDY
Subject: HousE F~~A~.S L~~
i ~~ ~~~
COMMENTS: 13uc-KFIoRN Gs. t_ai J e~ /4930 ~~' A~~. S.E.
gu(zP1~t1 ~~ L.oT 9~ ~v~7~ `d 9~' qua. 5. ~ .
** li' ou do ~~1 r~ceiv~ alb co ies ~~ any ~~~py is r~~t l~~i~le, p~~~~ call ~3f ~) 458»841 ~
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as soon as E~ossi ~,
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CITY OF YELI~1 I\SPECTION LOG
PROJECT
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PER.'~91T'~l'!~1IIER
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SET B.~CtiS D~te:
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OTI{ER CC~f~I"1e',',s
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Ccn~mer,ts ~~~~ ~~,~
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~~ Community Development Department
Building Division.
Phone: (360) 458-8407
L Fax: (360) 458-3144
WAENINGTON
Ap~(icant:
Name: Evergreen State Builders
Address: P.O. Box 39753 City: Lakewood
Permit No: BLD-05-0351-YL
Issue Date: 1011912005
(Work must be started within 180 days)
Receipt No: 38663
Phone: 253.475.6622
State: WA Zip 98499
Property In~orrnation
Site Address: 14930 89th Ave. SE
Assessor Parcel No. 37540001800 Subdivision: Buckhorn Estates Lot: 18
Contactor Information:
Name: Evergreen State Builders Contact: Medina, Ed Phone: 253-475-6622
Address: P.O. Box 197 City: Lakewood State: WA Zip: 98499
Contractor License No: EVERGSB980P6 Expires: 10102106275 Business License:
Project. Infiormation:
Project: Buckhorn Estates
Description of Work: 2502S126 SFR, Lot 18
Sq. Ft. per floor: (1st) 1034 (2nd) 1467 (3rd) 0
Heat Type (Electric, Gas, Other): GAS
Fees
Item
Building Permit 100-500k
Building Plan Review
Mechanical Permit
Plumbing Permit
Sewer ERU
Sewer Inspection
Water ERU
Water Meter (SFD)
Water Deposit
Traffic Facilities Charge
Sewer Deposit
State Building Fee
TOTAL FEES:
Item Fee Base Amt Unit Fee
1,676.95 993.75 683.20
708.51 0.00 0.00
78.25 0.00 0.00
132.00 20.00 112.00
5,417.00 0.00 5,417.00
145.00 0.00 145.00
1, 500.00 0.00 1, 500.00
300.00 300.00 0.00
40.00 40.00 0.00
757.50 0.00 757.50
50.00 50.00 0.00
4.50 4.50 0.00
$10,809.71
Garage 461 Basement 0
Unit Rate No. Units Unit Desc
5.6000 122.0000 $1, 000
o.oooo o.aooo
0.0000 0.0000
7.0000 16.0000 Fixture
5,417.0000 1.0000 ERU
145.0000 1.0000 ERU
1, 500.0000 1.0000 ERU
0.0000 0.0000
0.0000 0.0000
750.0000 1.0100 Peak PM Trip
0.0000 0.0000
0.0000 0.0000
Applicant's Affadavt:
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor, I futher certify that I am currently
registered in the State of Washington.
Signature Date ~~~~~~~`
Firm
tJFFICIAL USE 4N~Y ~1
# Sets of Prints:
'I~
~ina1 Inspection;
Date:'
ey:
~~~~f~~ -~~~ ITS ~
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o. Dix 479
~'el~, ~~~ 98597 E~Ei~T ~~.
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~~~~2 36L-45$-8403
ti:A 3r;INi:T01:
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* * * `TEN THOUSAND ONE HUNDRED P`Tt T~ SEVEN DOLLARS Sc 46 CENTS
RECEI~jED FROM DATE REC. NO. AMOUNT
EVERGREEN STATE BUILDERS 10/19/05 38661 1®,157.46 CHECK
P.O. BOX 39753
LAKE~k~00D WA 98499 BUDGETARY
BLD-05-0355-YL
LOT 16
REF. ~CJ7 PEN
PERMIT1223.35,PLAN516.86,MECH78.25,FLUM125,SERERU5417,00,SEWINSP145,WTERUI
WTt~ET300. , WTDEP40. , TRAFF757.50, fiE~~rDEPS@. , STAT4. 5@
~~ ®`~~~~ ~~~ k '
tv f
``, ~'~
~ CITY ~F
~~~~
P O. aox 479
~'~Im. Y'UA 98597
~~~,
'A'F :-MiNa'.T04' 360-458-403
t- ! -- ~ t. ~~"1r
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RECEIPT No. 3 8 6 6 2
****TEN THOUSAND SIX HUI~'DRED FIVE DOLLARS & 8$ CENTS
RECEIVED FROM DATE REC. N0. AMOUNT
EVERGREEN STATE BUILDERS ~Y.~!19/05 38662 10,605.88 CHECK
P.O. BOX 39753
LAKEWOOD WA 98499 BUDGETARY
BLD-05-0356-YL
LOT 17
REF.
f C%~~}~
PEN
PERMIT1533.31,PLAN647.8`,~~~£CH78.75,PLUM132.@@,SE~~~INSP145.00,WTERUIS@0.@@
WTMET300,,WTDEP40.,TRAFF757,50,SEWDEP50.00,ST4.50,SEWERU5417.00
~..... _ ~_ _ - _- _ - __. _~.._..__ _...__ _.._ ~. _.. ~..__._..~. _. ~. _..~.._.__ _..... _.._.,....~. r..__ _.__ ~.__._...__. _...._._._..~. _. -~ ,.._..,..~. _._. __. ~. w _.. _..~ _ _ ._ _._ _._...__ -_ __ ~.. _._ ._.. ~ __..,._.. __. ~.
i
°~~~~~~`' CITY (~~
~~~. ~,~~
~LI~I
a 0. t~cx 479
Y~I~,1~~VA 98597 ~~~ ~. ~ V ~ ~1
~ 360-458-8403
wa~:wiN~row
~~c~EIS~IED
****TEN THOUSAND EIGHT HUNDRED NINE i-4LLARS ~~ 71 CENTS
RECEIVED FROM
DATE REC. N0. AMOUNT
REF.
l~s
EVERGREEN STATE BUILDERS 10/19/05 38663 10,809.71 CHECK PEA
t
P.O. BOX 39753
LAKEWOOD 'rdA 98499 BUDGETARY
BLD-05-0357-YL
LOT 18
~~.
~- MICHELLE
PERI'~iIT1b76.95, PLAN708. 51,MECH7£i, 25, PLUM132.Oa, SEWER5417. , SE~r~Ih8P145, WTEFUI
tr~~,~t.,m~~~r~ t.rmn~nn~ m~ntr+r~~~ G~ ~~'G.IT1S~'D~GI ~hA ~Td 5~
Ye 1 m Community Schoo 1 s
Po Box 47fi
Ye 1 m , WA 98597
Clerk; Croy
Terminal; 1
Rece i t ; 7fia9
Manua Receipt ;
EVERGREEN
DISTRICT OFFICE
EVERGREEN STATE, BUILDING LLC
1 ai 15/70x5 1 a ; 29 AM
Qty Item Price
1 CPF15a0 1 a2fio , as
MITIGATION
BUCKHORN ESTATES LOTS 3, 4, B,16,17,'18
Subtota 1; 1 a~s6 , as
Tax ; 0 , o0
Tot a ~ ; 1 also , ao
Check 1 a~so . 0a
1 aoss
Amount Due ; a , a0
16163 2685 11:21 25`2843183 CAS RES h~~~. TDM PAGE ~?11 ~
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14830 89th R,VENLtE SOL {ST Receive
mHiT,~SfiON GQLTN'I'Y, W.A
~~xc~ pro. ~zs~ooay~oo OCT 1 0 2005
LOT 18
EVERGREEN STATE BUILDERS
auc~oarrnsTnrss
$9th AVE. S~
C'~"~ JI~~ ~LhiN CUL~QF SAG
RegdadY Dplp~ InG
~' NaI2TN
~ 20Q5 CASCADE RE5IDENTII.IL. bESIGN, iNC_ ~aL~ J" Z0~
THIS DRAWIMf~ ~, F~ASF.D ON i:I,IENT-PRDVIbEb INrnA~fATfbN RF.PRF~f~ITl:b T~ HF hC~UfiASE
ANA RFI.IARI.F~ I~IJ'1 oi~cr~~rANCIE$ gEtWEF,hI Thy, E~RA4Y1N0 ANR TIC AC~'iJAI SITE' C4hlbl'tI~NS
ARF. THE :¢hI,F ~7~5PdN51RII,I7Y bF THE CLIENT.
CITY CAF YELL
RESIQENTIAL St11t.QING PERMIT APPL"`~.TIC~N Ft7RM
. ~ ,~~
Proyect Address:,~~ ~ v' I
Subdivision. ~- ~,.. ~ ~ D
Lot #. Zonm , ~ _
g
New Construction U Re~Model ! Re~Roaf t Addition u Home Occupation Sign
U Plumbing U Nlechanicai U Mobile l Manufactured Home Placement U Other
Prv~ect Descriptionl5cope of Work: ~ ,~ ~
L~
Project Value:~~~,10,~~~
Building Area esq. ft~ ~ ~` Floor~,~~ ~'~ Floor,~~. D~ Garage ~ Deck ~g
~1~
Basement CarportPatio
# Bedroams~ # Bathroarns 3 Heatin . GA OTHER or ELECT '
RIC Circle Ones
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany perr~it application.
GENEFZAI. CONTRAGTOR~~,~i~. ~ DWI~~~ TELEPHONE
ADDRESS " - .-..
r1YrWYWrt Y~YYr~Y.11Y~Y.Y~YinY ,_~EMAIL
....~I ,f^~~~
CITY _STATE~ZI P FAX
CaNTRACTaR~s LICENSE # ~~~.~ ~.xP ~ATE~,CITY uCENSE #
PLUMBING CONTRACTOR ~~ ~
ADDRESS I ~~ ~,~~, ~'
CITY //~,Ty STATE ~Cd,.r~ SIP
rr r if - u . rwn. .,.~.rr.YrY„~,
CONTRACTOR'S LICENSE #
r~~~ I I„II~YiWW~YYiYYY
EMAIL
IR.~.IYYY~YY I ~~
~~~ FAX ..~".~ ~' - ~' ~
~~ 111 ~,Y~YiYI~ i YrY1YrrYYI~~~~
EXP DATE~,CITY LICENSE # -_
MECHANICAL CONTRACT R ~f~f ~ ~' ,TELEPHONE ~Z. ~ ~~~
ADDRESS ~.5~7 /~ EMAIL ~ (~ C~
CITY ~ ,~,I~,STATE ~ ~I P ~' ~`G~ S~ ~ FAX ~'.~ ~`,~ ~ ~ -~ /~'~(j~/R/' ~ C.~
~~~ ~ ~Yr.~YY~1i1 IIYYY~.Y~Y~r.' lrfjlY~r.lY~liWA~YYIYYIM~
CONTRACTOR'S LICI~,NSE # EXP DATE CITY LICENSE #
-- - -------- ........I,.
Copy of mitigation agreement with Yelm Community Schools, if applicable.
!hereby certffy that the above i~`ormartion is correct and that the construction on, and the occupancy and th$ use of the
above described property wiii be in accordance vrith the iallYSt rules and regulations of the State of W89hington and the
City of Ye1m.
---- --.__ _ u ~wwrwlwwrwn~+^wM.rrrrrrrrr.rnwnrwrr v G.7
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Applicant's Signatur~~ pad
t~wner I Contractor ! Owrner's Agent !Contractors Agent please circle one.
Ali permits are non~t~~ans~erable and will expire if work authorized by such permit is not begun
within X80 days of is:~usnce, or "rf work is suspended or abandoned rtor a period of 1 R4 days
I05 Yetr» Auenue i~Y~est (36d} 45~-383
PLi $ox d 7'9 (360 ~5B•31' 4~t FAX
Yelm, WA 9859?' wwr~.c~.yelm.r~a.ue
ARCHITECT/~NGINEER L`Gt ~/,~~ -~~i~/,ICENSE #
ADDRESS /v~ ~Q o~ EMAII.
CITY ~.1e L~OYI'J~ -STATE Gfi1 ZI~ t~ TELEPHONE ~ ZS ~ -,~ "7Q