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FROM :YELM SEWER DEPT.
FAX N0. :360-458-8166 Jun. 23 2006 01:27PM P1
10f TNT P,~'I
;° ~, FAX TRANSMISSION
y~LMa o~ CITY OF YE[,M
P.O. BOX 479 - )31 NP ROAD NE
YF;LM, WA 98597
360-458-8411
C~'~~ r~x 36o-ass-s ~ ~~
TO: ~.R NON
FAX#:
From: R~tir~~
DATE: b-a3-o~
p~1G~S: 1 ,including this
Cover sheet
Subject: NoUSG fi'~A~'/ gUCk~pRN C'ST~
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~ ~ 1 i you do nc~l rece~~re A1I coP~cs or any py
as soon a~, possible,
NEW COIYSTRUCT-ON
WATER INSPECTION
DATE:
DEVELOPMENT:
LOTn 3 ~~
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LOT
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CITY OF YEL~1 INSPECT10;~1 LOG
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OTItER Cc~~~~:,ts
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C~n~mcr~;s
o~T~a City of Yelm
,~ Communi Develo ment De artment
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Building Division
Phone: (360) 458-8407
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WAiNINGTON Fax: (360} 458-3144
Applicant:
Name: Evergreen State Builders
Permit rvo: BLD-OS-0354-YL
Issue Date: 10119/2005
(Work must be started within 180 days)
Receipt No: 38658
Phone: 253.475.6622
Address: P.O. Box 39753 City: Lakewood State: WA Zip 98499
Properly In~o~ation.
Site Address: 14949 89th Ave. SE
Assessor Parcel No. 37540000300 Subdivision: Buckhorn Estates Lot: 3
Contractor Infarmatlon:
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: EVERGSB980PB Expires: 10102106275 Business License:
Rroject Ir~ormat~on
Project: Buckhorn Estates
Description of Work: 222913 SFR, Lot 3
Sq. Ft. per floor: (1st} 1038 (2nd) 1191 (3rd) 0 Garage 728 Basement 0
Heat Type (Electric, Gas, Other): GAS
Fees.:
Item Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
Building Permit 100-500k 1,625.43 993.75 631.68 5.6000 112.8000 $1,000
Building Plan Review 686.74 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 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 E R U
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
Sewer ERU (LID) 2,769.00 0.00 2,769.00 2,769.0000 1.0000 ERU
State Building Fee 4.50 4.50 0.00 0.0000 0.0000
TOTAL FEES: $8,074.42
Appllnt'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 ,~ • ~~.,~
Firm „~ ,~
OFFICIAL USE C}NLY
# Sets of Prints:
.Final lnsp~ection:
Date; ~ +~~
,By:
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~` * * * EIGHT THOUSAND SEVENTY FOUR DOLLAF~S ~' 4 2 CE~dTS
EVERGREEN SI`ATE BUILDERS 10!19/05 38658 8,074,42 CHECK
~~~S`"
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Rio , ir~~.
PENDING`
P,O. BOX ,Sg~753
LAKEW~~4. WA 98499 BUDGETARY
LO ,~~~ BUCKHORN ESTAT,°ES
B -05-0354-YL
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~'ER~~iIT1625.43, PLANREC'~86.74, ~~ECH78 , 25, PLU;118.00, SEWINSP145.00, ~~JTER~T1500. ,
~r~TR~~ET3@0, 00, WTRDEP40. , SE~~tDEP50. , TRA~'F757 , 50, SEWERU2769.00, ST4.50.
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* ~` ~` *SEVEN THOUSAND SEt~'E?~' HUNDRED SEVENTY THREE DOLLARS & 3@ CE~iTS l C~5'lrS
EVERGREEN STATE BUILDERS 10/19/05 38659
F,O, BOX 39753
LA~{~'WOOD ~~dA 98499 BUDGETARY
LOT 4
BLD-05-0352-YL
7, 773.30 CHECK PENDING
~~iIC:HELLE
FERI~IT1413,75,PLAN597,30,~~~CH78.25,PLUt~~.18,00,SERERU2769,0@,SEINSP145,00
WTRERU150~-.00,WT~~ET300.,WIDEP40,,SEWDEP50,,TRAFF757.50,STAT4. 50
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~~**TEN THOUSAND SEVEN HUNDRED TWENTY TWO DOLLARS & 42 CENTS
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ES~'ERGREEN STATE BUILDERS 10/19/05 3$660 10,722.42 CHECK PENDING'
a
P.O, BOX 39753
LAKEWOOD WA 98499 BUDGETARY
LOT 5
BLD-05-0353-YL
PER~~iIT 1625.43,PL~~N636.74,MEC'H78.25,PLUl~i118.,SERERU5417,00, SEWINSP145.00
WTERU1500,00,WT~iET:X00,,WTDEP40,,SEt~tDEP50,,TRAFF757,50,STATE4,50
Ye 1 m Community Schoo 1 s
PD Box 476
Yelm, WA 98597
Clerk; Croy
Terminal: 1
Rece i t : 7609
Manua Receipt ;
EVERGREEN
DISTRICT OFFICE
EVERGREEN STATE, BUILDING LLC
10/ 19/2006 10 ; 29 aM
Qty Item Price
1 CPF2900 10266 , 00
MITIGATION
BUCKHORN ESTATES LOTS 3,4,5,16,17,18
Subtotal . 10766 , 00
Tax; 0.00
Total ; 10266.00
Check 10266 , 00
~ a~66
amount Due ; 0 , 00
10/0312005 11:21 2"?8433.~~ CAS RES ~Ui~~r- TDN1 PAGE 02/10
i ~~~
avc~or~v.~s~~~~ ~ec~ived
X4949 89th AVEN'C]E SpTJ'J,'kI'F,,,~,ST
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~HI~ gRAYVINp f5 9A550 Ohl CU~NF-Pp{~~li}F.i3 iiVFURMATI{JN RF.PRESFN7~t5 t0 HE ACCURA1f
ANb C~~L~A~I.~, AMY 1JI5CR~PANCIES AETY'E~'H TH15 ~}RAWINO A,ND TH;; ACTUAL rll~ CL1N~lITIf~NS ~w~Am ~ar~ rR~I~G1'4
ARC 'fW~ r~~.E RE?~~4>v~i~ll,l'~Y D~ THE CI.If:MT~ H-~•9~b J19 }~0}~061lb
crTY of YELM
~SIDENTIAL ~I11LDlMG PERMIT APPLIC ~~~N CORM
Protect Address:~~!~ ~' ~ #; ,~~~
Subdivision: ~ 1~.. ~ ~ ~ .
Lit #.,~3 _ Zonin ,
g
New C~nstructlan U Re~Model 1 Re-Roof 1 Addition ~ Home Occupation Sign
U Plumbing U Mlechanical U Mobile !Manufactured Home Placement U Other
Project DescriptionlScape of Works ~ ~ 5~
Project Valuer~~ ~ ~
Building Area (sq. ft} 1~ Floor~Q~ 2"~ Floor//~/ Garage ~~ ,Deck
Basement CarpartPatia "" /.~.
# Bedrooms # Bathrooms '' -~5 I~leatin . GASI THER ar ELECTRIC Circle Ones
Are there any environmentally sensitive areas located an the parcel? If yes, a
completed environmental checklist must accompany perr~it application.
GENERAL CGNTRAC~TC?R ~IWI~ TELEPHONE
ADDRESS EMAIL
CITY _,STATE~ZIP FAX
CONTRACTOf~'S LICENSE # P DATECITY LICENSE #
PLUMBING CONTRACTOR G~. ,~ TELEPHONE~2~.~~ .~~ ~~~~
ADDRESS ~ ~~ ~ 1 EMAIL
CITY //////,,,,,,//////~~II STATE ~: ZIP ~' FAX ~.~~ `~~~ ~~
~ Y ~I Mlrrl
Ct~NTRACTOR'S LICENSE # EaCP DATE~,CITY LICENSE #
ME~HAIVICAL ~oNTI~AcY R ~ TELEP~IONE ~.~
~- ~-
ADDRESS ~ ~~~~ f~ ~. EMAIL ~ ~~ ~~~~.~
CITY yr1 __STATE c~.~~ ZIP ~'~C .S' ~.' I`AX ~'-~~ ~"' ~ ~M~'.~ ~ ~
CONTRACTOR'S LICENSE # EXP DATE ~---- CITY LICENSE # ~.~
....._..
Copy of mitigation agreement with Yelm Community Schools, if applicable.
# hereby certify that the above ~ni`ormation is Correct gnd that the construction +~n, and the occupancy and the use of the
above desoribed property wiii be in accordance with the iawst rules and regulations of the State of 1Neshington and the
City of Ye1m,
Applicant's Signature Date
Owner 1 Contractor !Owner's Agent ! Contractor's Agent Please circle one.
All permits are non-ti~ansferabla and will expire if work authorised by such permit is not begun
within 180 days of issuance, or rf work is suspended or abandoned for a period of 1 ~Q days
I05 YeYm A~ertue West - - - - -- ~3so) 4~~-3835
~o ~x 4 fig {ssoy ~~~~~ 4~ a~Ax
Yerm, WA 9859fi rvwr~.ci.yeYm.wa.+~e
ARCHITECTJ~NGINEER °Gt C~ ~,/~.L2 c~'.~S[~tisCL~j~.ICENSE #
ADDRESS f. vo7 ~ o~ EMAIL
CITY ~Ce ~1~'Ia ,STATE ~ ZIP ~~~TELEPHONE ~ Z~ 2- -~ '7L3