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FROM :YELM SEWER DEPT.
FAX N0. :360-458-8166 Aug. 18 2006 11:16AM P1
a VIE iXt p~
C~,~l~ FAX TRA.NSMISSI~N
~~yy~,~e ~ CITY OF YEI.M
P.O. BOX 479 - 931 NP ROAD NE
YELM, WA 98597
360-458-8411
FAX 360-458-8166
'T'O: G2C ~ DATE: ~- / 9- O ~
FAX#: PAGiS: / ,including this
Cover sheet
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o~ ~~ City of Yelm
Communi Develo ment De artment
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Building Division
Phone: (360) 458-8407
L Fax: (360) 458-3144
WAiNINGTON
Applicant:
Name: Evergreen State Builders
Address: P.O. Box 39753 City: Lakewood
Permit Ivo: BLD-05-0355-YL
Issue Date: 1011912005
(Work must be started within 180 days)
Receipt No: 38661
Phone: 253-475.6622
State: WA Zip 98499
Property Information;
Site Address: 14918 89th Ave. SE
Assessor Parcel No. 37540001600 Subdivision: Buckhorn Estates Lot: 16
Contactor lnforrnation:
Name: Evergreen State Builders Contact: McCullem, Tom Phone: 253-475-6622
Address: P.O. Box 39753 City: Lakewood State: WA Zip: 98499
Contractor License No: EVERGSB980PB Expires: 10102106275 Business License: 1042.0
Project°Informaon;
Project: Buckhorn Estates
Description of Work: 152812 SFR, Lot 16
Sq. Ft. per floor: (1st) 0 (2nd) 0 (3rd) 0 Garage 0 Basement 0
Heat Type (Electric, Gas, Other):
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
Building Permit 100-500k 1,223.35 993.75 229.60 5.6000 41.0000 $1,000
Building Plan Review 516.86 0.00 0.00 0.0000 0.0000
Mechanical Permit 78.25 0.00 0.00 0.0000 0.0000
Plumbing Permit 125.00 20.00 105.00 7.0000 15.0000 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 E RU 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
TOTAL FEES: $10,157.46
Applican#'s Affadav#:
OFFICIAL USE ONLY
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 inconformity with all applicable City of # Sets of Prints:
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. Final .Inspection:
Date:
Signature ~ ,-~~ „ _ _ Date ,~~ ,~~
ley: ~o
Firm
~: ~ { ^ i ~ s ~~~ ~ f ! ~ Fs a ~1 ~.~
f~¢ ~~ ~~~~~~~~
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~ '~'~1m.1~vA 989' ~~~~~~ ~~. ~ V ~ ~ ~.
3~~-458-8403
Wa~e<INI:iOM
~ s\ar~ zl ~~ir'
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****TEN THOUSAND ONE HUNDRED N`TF`~Y SEVEN DOLLARS ~ 46 CENTS
~rr~.~- rR
~~..;~~Fv'~u FR M
DATE REC. IvO.
AMOiJC~T
EVERGREEN STATE BUILDERS
P.O. BOX 39753
LAKE~~~OOD WA 98499
BLD-05-0355-YL
LOT 16
10/19105 38661
BUDGETARY
10,157.46 CHECK
REF.I
I~~~
PEN
1
PERMIT1223.35,PLAN516.86,t~~ECH78.25,PLUM125,SERERL'5417.00,SEWINSP145,WTERUI
WTtF~ET300. , WTDEP40. , TR.AFF757.50, SE~~'DEP50. , STAT4.50
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RC. Box 4r0
fir. i~iL ~vL-T~L-VTV~
1SI 5Y5l.ti C-?GiE
****TEN THOUSAND SIX HUNDRED FINE DOLLARS & 88 CENTS
4~'-'~~'~=~ FROM DkTE REC: X10.
EVERGREEN STATE BUILP~ERS ~~; 19/05 38662
P.O. BOX 39753
LAKE~~=OOD WA 98499 BUDGETARY
BLD-05-0356-YL
LOT 17
fiMCUh-T REF.
~c~~
10,605.88 CHECK PEN
PERi~IT1533.31,PLAN647.82,i~~ECH78.75,PLUM132.00,SEWINSP145.00,WTERU1500.00
WTMET300.,WTDEP40.,TRAFF757.50,SEWDEP50.00,ST4,50,SEWERU5417.00
+~ '~ 1
w ~ ~~
i
~. Box ~~~
~ 300-4~8-8403
I
****TEN THOUSAND EIGHT HUNDRED NINE DOLLARS ~~ 71 CENTS
RECEIL'ED FROP~~ DATE REC. N0. A"~IODN T REF.
~~s
EVERGREEN STATE BUILDERS 10/19/05 3$663 10,809.71 CHECK r`EA
P.O. BOX 39753
LAKEWOOD ~~A 98499 BUDGETARY
BLD-05-0357-YL
LOT 18
r
~~~
~~ICHELLE
PER1~~iIm167~. 95, PLAN708. 51,MECH7S. 25, PLUM132.00, SE~~ER54 ~ f . , SE~`~INSP145, ~~TER.U1
ttDkiL~m'~r~~7- GimnL'-Dnrl- m~n~r~~~ ~~ ~~'G1Il~'~FA fA(II ~Td ~Of
Ye 1 m Community Schoo 1 s
Po Box 47fi
Ye 1 m, WA 98597
Clerk; Croy
Terminal: 1
Rece i t ; 7609
Manua Receipt ;
EVERGREEN
DISTRICT OFFICE
EVERGREEN STATE, BUILDING LLC
10/ 19/2005 10 ; 29 AM
Qty Item Price
1 CPF2900 10766,00
MITIGATION
BUCKHORN ESTATES LOTS 3,4,5,16,17,18
Subtota 1: 10266 , 00
Tax; 0.00
Tata 1; 10266 , 00
Check 10266 , 00
10566
Amaunt Due ; 0.00
1011012005 12:02 2543183 CAS RES NWA~~TDM PAGE 03
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EVERGREEN STATE BUILDERS
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THIS DaAWINf,; I; BASEb ON CLIENT-PRt~VIDED INFDRI~IATION Rct-sxF.~N~A Tb ~E ACCURATE
AND RF.LIARLF. ANY h4~REPnNC1~5 RE1'H-~EH THIo DRAI~IINC ANA THE, ^~1l,lAL SITE CbNDI~IDNS
ARE THE SOLE RF.SPONSi~II,iT~' ~F TFf>' OLI~N`t~
crTir of YELM
RESIDENTIAL. BUILDING PERMIT APPI '~"'~~~1TIC?N CORM
Project Address:,~'1,~~ ~'~ r,~~~l ~~ #:~ .,
Subdivision: ~~ 1~, .
Lot #. Zonin ,
9
New Construction u ReWMadel ! Re-Roof !Addition ~ Nome Occupation Sign
U Plumbing U Mechanical U Mobile !Manufactured dome Placement u 0#her
Project Descriptionl5cape of Work. ~ ~ ~ ~
Pro ect value: ~Z~ ~ ~ 1 ~~ v
~ b
building Area ~s~. ~} ~ ~ Floor~~~ ~"~ Fl+oar Gar a Deck
~~ ~
Basement Carport~Patio 2,~/
# Bedrooms # Bathroams,,,~•t.l~ I"ieatin . ASl THER or ELECTRI i
C ~C rcle One}
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmer~tal checklist must accompany permit application.
BUILDING OWNER NAME:
ADDR~SS ''~~fIS- ~~
CITY D STATE
ARCHITECT/~NGINEER Gt
ADDRESS. v~ J D o2 !~
CITY ~Ce ~»~l STATE
~~i~ ~
Z!P __TELEPHON
SIP
~.ICENSE #
IEMAIL
TELEPI~IONE ~
'~I~~3
GENERAL CONTRACfiCiR.~,l ~'~~~~~ ~'ELEPHONE
r.l....~r.lr r.~. ~.Il~rrlrl
ADDRESS EMAIL
r1.~.11Wr r~11IIMwYU~Ir1Y .rlrY I .Irrw r..lr
CITY _.STATEZIp FAX
CONTRACTOR'S LICEENSE # .: P DATE~CITY LICENSE #
PLUMBING CONTRACTOR ~. , ~ TELEPHONE~~~~..~.~ C.~~
ADDRESS / .1 ~ EMAIL
//r~• /,/~ 7 AJV~ ~7'] .r~(~r//lam'/'~~r Y~1•r \i -.lir i.p~
C I Ty r I. rl ,STATE ~ ZI P..cF/ V • ~ ~•a. -`~~~~,i'~°_~ ~~~~~.11/(/////////pppp
rr~. III 1 II~~ .rY.
CONTRACTOR'S LICENSE # EXP DATE,~,CITY LICENSE #
MECHANICAL CONTRACT R ~~~~~~
ADDRESS ~ ~~~ .~ ~~ ~
CITY 1~'1 „~1~„STATEZIP
CONTRACTOR'S LIC~:NSE #
~~~'~~' TELEPHONES ~.~
~~
EMAIL ~ _ (~ C'
~'~'C ~r ~? FAX Lfi ,7 ~` ~ ~
I ~.Yi~Y.Y~lYrii.llllri .___.
EXP DATE_ CITY LICENSE #
Copy of mitigation agreement with Yelm Camrnunity Schools, if applicable.
# hereby certify that the above information is correct and that the construction on, and the occupancy and th$ use of the
above described property wiii be in accordance with the laws, rules and regulations of the State of Washingttm and the
Gity of Ye1m.
_ `, .~~ ~ .. /fir ...Q~""~
Applicant's Signatur+a Date
Owner !Contractor ! t~wner's Agent ! Dontractor's Agent Please circle one.
All permits are non-ti•ansferabla and will expire if work authorized by such permit is not begun
within 180 days of is:~uence, or " work is suspended ar abandoned for a pei~od of 180 days
,I05 Ye~m Avenue Weet - -- - - -~-- - (360} 45~-363
Pd ~3ox ~ 7g (360) 458-~I ~~1 ~"AX
Yeim, OVA 985'~fi rvu~ru.ciy~Ym.wa.+wr