BLD-05-0353CITY OF YELn1 I;~SPECTION LOG
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o~ T~~ City of Yelm
Communi Develo ment De artment
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a
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
WAlNINCTON
Applicant:
Name: Evergreen State Builders
Address: P.0. Box 39753 City: Lakewood
Permit No: BLD-05-0353-YL
Issue Date: 1011912005
(Work must be started within 180 days)
Receipt No: 38660
Phone: 253.475.6622
State: WA Zip 98499
Property Informataan:
Site Address: 14925 89th Ave. SE
Assessor Parcel No. 37540000500 Subdivision: Buckhorn Estates Lot: 5
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: EVERGSB980PB Expires: 10102106275 Business License:
Project Information:
Project: Buckhorn Estates
Description of Work: 2229!3 SFR, Lot 5
Sq. Ft. per floor: (1st) 1038 (2nd) 1191 (3rd) 0
Heat Type (Electric, Gas, Other): GAS
Fees:
Item Item Fee Base Amt
Building Permit 100-500k 1,625.43 993.75
Building Plan Review 686.74 0.00
Mechanical Permit 78.25 0.00
Plumbing Permit 118.00 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: $10,722.42
Garage 728
Unit Fee Unit Rate
631.68 5.6000
0.00 0.0000
0.00 0.0000
98.00 7.0000
5,417.00 5,417.0000
145.00 145.0000
1, 500.00 1, 500.0000
0.00 0.0000
0.00 0.0000
0.00 0.0000
757.50 750.0000
0.00 0.0000
Basement 0
No. Units Unit Desc
112.8000 $1, 000
0.0000
0.0000
14.0000 Fixture
1.0000 ERU
1.0000 ERU
1.0000 ERU
0.0000
0.0000
0.0000
1.0100 Peak PM Trip
0.0000
Appticanfi's Affidavit:
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor, I futher certify that I am currently
registered in the State of Washington.
Signature .~._ . _ Date ~/,~••,~ „~„`
Firm
OFFICIAL USE ONLY
# Sets-of Pdnt~:
Final Insp~sct[an
Date: ~
`' By:
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* * ~` *EIGHT THOUSAND SEVENTY FGUR DOLLAP~S ~ 42 CE~Z?~S ~~~~5
u~~`'v FR~~r~ DATE RE . ~t0. ,~,~,~v~.R~ T RAF. i r~.
E~'ERGREE~i STATE BUILDE:~S 1@/19/05 3865$ $,04.42 CHECK PENDING;
P,O, BOX 39753
LAKEWOOD WA 98499 BUDGETARY
LOT 3 BUCKHORN ESTATES
BLD-05-0354-YL
C ELLS
PER~1IT1625, 43, PLANREC~i$6.74, t~ECH7$. 25, PLUi~i11$ .0@, SEi~INSP145, 00, ~^~TERL'1500. ,
~~~TRMET300,00,WTRDEP40,,SE~~~DEP50.,TRAFF757,50, SEWERU2769.00,ST4.50.
~i .•,~; 9
,' s
`' ~~~~
~' ~ ~ ~^
is€ .--- 3 }~ ~ i
~Y
* ~` * *SEVEN THOUSAND SEVE~~ HLsNDRED SE'JENTY THF,EE DOLLARS & 30 CENTS ~~~'(C'
'~~.~'S,t~1 ~~~~~~ ~HT~ RAC. iVLr''. r11v~'tin,'~.Ji~Y ~`FI". ~il.~`.
EVERGREEN STATE BUILDERS 10/19!05 35559
P,O, BOX 39753
LAKE~'JOOD WA 98499 BUDGETARY
LOT 4
BLD-05-0352-YL
7,773.30 CHECK PENDING
i~1IC'HELLE
PERMIT1413,75,PLr~N597,30,~~1ECH78.25,PLUM+18.00,SER.ERU2769.00,SEINSP145,00
WTRERU1500,00,WTMET300,,WTDEP40,~SE~JDEP50,,TFAFF757,50,STAT4,50
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***TE N THOUSAND SEVEN HUNDRED
EVERG REEN STATE BUILDERS
P.O. BOX 39753
~YrJyrwn.w.riN i:.,.
LAKEWOOD,,,,.~~~'A 9 S 4 ~ ~,~
LOT 5
BLD-0~5-0353-YL
' ~,.
TWENTY TWO DOLLARS & 42 CE~~TS
DHTE REC. N~. 1~~i1~?UP~T
10/19/05 38660
10,722.42 CHECk
BUDGETARY
~~.^~C.
~I~
PENDING
PERi~iT~`T~.a....1.,6.2-~5~~;~4'~3, PLAN63G . 74, MECH7S . 25, PLUM118. , SERERU5417 , 00, SEWINSP145.00
~~TERU1500,00,WT~~ET300,,WTDEP40,,SE1{~DEP50,,TRAFF757,50,STATE4.50
Ye 1 m Community Schoo 1 s
Po Box 47fi
Yelm, 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 10266 , 00
MITIGATION
BUCKHORN ESTATES LOTS 3,4,5,16,17,18
Subtotal . 10266 , 00
Tax; 0.00
Tota 1; 10266 , 00
Check 10266 , 00
l 066
Amount Due ; 0.00
1 ~~ 0312~~5 11.21 n~3~843183
PAGE 04/10
1492s 69th .Fi.V~ Spi~~' Q
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rVERGREEN STATE BUILDERS
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THIS ~R~+NIM~+ Jt ~+45ED QN CI,IF.NP-P'~l~V~f1~n ~Nf O~R~I~ITIh~1 A~p~~u~N1`~n TD RF tiCCI~p,M1~'~
ANq Rr~,l~1pL~, ANY DISAAF;I~Ahlrl~S ~~i'V4~FN 7H~~~ 17RAVr~N~ nhlf' 1'~~ IIC~UAI. ~IT~' GO~ID141bN5
naF ri~r ^qlr RE~~tlr~~:~~it.,~rY n~ THE CllF.'NY.
~.
t~l 1 T OF 1rELl~
~~"SIQENTIAL BUI~.QIhiG ~'ERI~~` A~PtIC. ~ . ~C1N ~ORN~
Pra~ect Address: ~ ~ P/~~ ~;
irr
Subdiv~sNOnY ~~ p 6 ~/' M
Lot #: Zonin ; .
9
New C~nstrur~lon U Re~Model ! Re~Rvaf !Addition u Horne
U Plurr~bin U Nlec Occupation S~c~n
~ hanical U Mobile !Manufactured Home Placement U Other
Project Descriptianl5cape +af Mork:
~~ ~~
P~ect Value: ;~~ ~~ ~~
Quiiding Area ~s~.1~} ~ ~ Fi~/~~;~ 2~ Flr~r Car v~
~~.~~.. ~e .~~, Deck
Basement Carpvrtpatio
# bedrooms # Bathrooms ~ ~~ Heatin .GAS! THER
or ELECTRIC tCirole One}
Are there any envirnnrnentaliy sensitive areas located on the arcel?
c+ampleted environrt~er~tal checklist must p If yes, a
acctimpany permit application.
BU1l.DiNG OWNER NAME: t ~~
ADDR SS 3'~I~- ~~( ~ ~ ,~-
CITY O _„STATE_ _ _ ' ZIP
ARCHITECT/~NGINEER GL ~~
ADDRESS_~S.~n ~,2
CITY 'TCe ~~+~1a _STATE ~f ZIP
GENERAL CONT'RACT'OR
ADDRESS
CITY` --- -___ -- ,....,STATE ZIP
CONTRACTOR'S LICENSE # ~~
EMAIL E,~/ ~?~
7'ELEPHQNE Cz~~~
~.ICENSE #
,EMAIL
TEt~EPHONE ~
~~
~' ~ TELEPHONE -
EMAIL
-. -- FAX
P ~A~'E~CITY LICENSE #
PLUMBING CONTRACTOR ~ ~ TELEPHONE _2~ ..~.~
ADD ~- ~ .~' ~~~
RESS ~ ~ - EM
CITY AIL
,_STATEZIP '~ FAX ~.~ 5' _ ~~
CONTRACTOR'S LICENSE #.._ EXP LATE ~ CITY LICEN ~~~ ~~.
~•--~.-- ~- 5E #
MECHANICAL CONT'I~ACT R, ~~~ ~ TEL~PI~IpNE ~'
ADDRESS ~~ ~ /°~ ~ .~".
~ EMAIL ~` .~
--~ ~ ~
CITY w STATEZIP ~~~,~~ ~? FAX ~' ~ ~ ~ ~.~
CONTRACTOR' ~ ~~ ~
S LICENSE #- _ __ - _ ~ EXP DATECITY LICENSE # ~~~.~.
Corry of mitigation agreement with Yelm Cornrnunity 5choais, if a iicabfe.
Pp
~ hereby certjfy that the above Information is cornett and that the canstnuction on, and the occupant snd the use of t
above described property will be In accordance with the laws, rules and re~uiationa of the state of 1Nashin orr ~
City of 'Yelm, gt and the
/ `~
v
Applicant's Signature
t~wner ! Cantractvr ! t~wner's Agent !Contractor's Agent
Qate
Please circle one~~
Ali permits are nonytransferable and will expir+~ if work authorized b such errnit is n
within 18t# day$ of is:~uance ar r"f work is ~ Y p at begun
suspended c-r abandoned for a period of ~ 80 days
IDS Yelm Au~nue Went ~~6D,} d6&3~3~'
P~ ~3ox d 79 (~6'D~ ~~'8~3Y ~~ FAQ'
YeIm,'WA 98~'9fi rvrva,.ciyeYm.raa.ae