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CITY OF YELT~9 INSPECTION LOG
P ROJ ECT~i,~~
PER.'~~IT'~U!~9BFR C~ . ' c~3.~
.ADDRESS I `~ 5 ~ I g ~' S~'
SET B.~CtiS Date: ',~ ~ ~ d~ FOOTI'N'G `~'.~
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FOOTI'~G REB.~R /'y Date: tip'
~ l~ .aLL REB.~R ~ .
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~ _ Other
~~ ~ Foa~~ and Seal ~ ~'a-~; r far; ier P~'
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C~nzments
SKEET ROC~,'c}~E.aR ~~'.aLL ~'.~IL
Co~~ments
OTI~ER Cc~r~ments
Se~~~er F:n;:l ~ Electric::l ~~ Civil Final ~ L4n~sca-,; Fir,;~l ~ ~ ~
.~ ~~ ~ ~ f _ C c f~
.ad~re~. _ lnsulat~c~n J Site Dra~n~~e ~ ~i~e~~ alb;
Cc~n~ments
FROM :YELM SEWER DEPT.
~~ TNT ''"l
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FAX N0. :360-458-8166 Mar. 17 2006 02:04PM P1
FAX TRANSMISSION
CITY OF YELM
P.O. BOX 479 - 931 NP ROAD NE
YELM, WA 98597
C~ ~~ 360-458-R411
~\~ FAX 360-458-8166
TO: (S 12~N1 /J r BATE: 3 - I l - o (q
FAX#: PAGES: ~ ,including this
Cover sheet
From: C~AN~Y
Subject: Wous~ FIn~ALS
b~.~~
COMMENTS: 13vcK 1.4oRw ~5T/~.o-[ ~~ Y9(o( $9'f6-'ASE. S,E,
PENNI~VV-ibN '65~C~LO"T' 37 IS"'3oZ4 roY*?' wA" 5.~,
~5-73~ o~
~~ I~ ou d~ not r~ce~v~ all ~o ies ~r any c~~y is nab t~~tble, pt~as~ ca~~ (3~0) ~~S-$~~ 1
Y P
~s soup ds ~~gsible.
" ~ T~ C i of Ye I m
O7
Applicant:
Name: Evergreen State Builders
Address: P.O. Box 39753 City: Lakewood
Community Development Department
Building Division
Phone: (360) 458-84
L Fax: (360) 458-3144
MIAiMIMOTON
Permit NO: BLD-OS-0351-YL
Issue Date: 1012512005
(Work must be started within 180 days)
Receipt No: 38776
Phone: 253.475.6622
State: WA Zip 98499
Property Information.
Site Address: 1496189th Ave. SE
Assessor Parcel No. 37540000200 Subdivision: Buckhorn Estates Lot: 2
Contractor 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: EVERGSB980PB Expires: 10102106275 Business License:
Project Informa~c~n:
Project: Buckhorn Estates
Description of Work: 221112 SFR
Sq. Ft. per floor: (1st) 1071 (2nd) 1140 (3rd) 0
Heat Type (Electric, Gas, Other): GAS
Fees:
Item
Building Permit 100-500k
Building Plan Review
Mechanical Permit
Plumbing Permit
Sewer Inspection
Water ERU
Water Meter (SFD)
Water Deposit
Traffic Facilities Charge
Sewer Deposit
Sewer ERU (LID)
State Building Fee
TOTAL FEES:
Applicant's Af~a~avit:
Garage 434 Basement 0
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
1, 562.71 993.75 568.96 5.6000 101.6000 $1, 000
660.24 0.00 0.00 0.0000 0.0000
78.25 0.00 0.00 0.0000 0.0000
125.00 20.00 105.00 7.0000 15.0000 Fixture
145.00 0.00 145.00 145.0000 1.0000 ERU
1, 500.00 0.00 1, 500.00 1, 500.0000 1.0000 E R U
300.00 300.00 0.00 0.0000 0.0000
40.00 40.00 0.00 0.0000 0.0000
757.50 0.00 757.50 750.0000 1.0100 Peak PM Trip
50.00 50.00 0.00 0.0000 0.0000
2, 769.00 0.00 2, 769.00 2, 769.0000 1.0000 ERU
4.50 4.50 0.00 0.0000 0.0000
$7,992.20
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor, I futher certify that I am currently
registered in the State of Washington.
Signature ; ` ~ _ _ Date ~ ~`
Firm
QFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date: 6 ~ ~'
By:
i
YELM COMMUNITY SCHOOLS 2 5 5 8 9
LOCAL RECEIPT DATE l 0' a s S a o 05'
Su13 d3- Fs3~f6~/L,
Received from _ f~ ~ ~~ .r o o A "'4`n ~~, f'~c 1 ~ LD~o ~,o
r
FOR Y1r1
~. °U COLLARS
---- nmwni
ass ~AJI1 GHtGK
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$ g`1 5 5 5, 0 0
YE M COMMUNITY SCHOOLS
By
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o~ T~ City of Yelm Permit Fees Schedule
Communi Develo ment De artment
r ~ p p
a
Permit No: BLD-05-0351-YL
Building Division
Phone: (360) 458-8407
WASNINOTON Fax: (360) 458-3144
Applicant:
Name: Evergreen State Builders Phone:
Address: City: State: Zip
Project Information:
Project: Buckhorn Estates
Description of Work: 221112 SFR
Site Address: 1496189th Ave. SE Assessor Parcel No. 37540000200
Fees:
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 Inspection 805 412-343-80-00 145.00 0.00 145.00 145.0000 1.0000 ERU
Water E RU 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
Traffic Facilities Charge 420120-345-85-00 757.50 0.00 757.50 750.0000 1.0100 Peak PM Trip
Sewer Deposit 742 402-389-01-00 50.00 50.00 0.00 0.0000 0.0000
Sewer ERU (LID) 802 412-343-50-01 2,769.00 0.00 2,769.00 2,769.0000 1.0000 ERU
State Building Fee 160 001-386-00-00 4.50 4.50 0.00 0.0000 0.0000
TOTAL FEES: $7,992.20
10/10/2005 12:02 25~"`~'43183 CAS RES NWArDM PAGE 02
LOT 2
EVERGREEN STATE BUILDERS
BVCRHORNASPATES
14961 Bath AVffii0E SO1T17iEASf
~°~'°N~°"~,°°" Received
rnxcII.xo. azssooozoo
OCT 1 0 2005
w ~~,
-~-r
g9th AV~• SE
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It/I/ IIII 11/ 1/
~ ~a~5 CASCADE RESIDENTIAL DESIGN,, INC. ~~~~~ ~~ : 2/~I
,THIS DRAYVING IS AASf;b QN (:I,IFNT-PRp1ryp~I~ iN~flRMATMI~ REpfiE`;ENT~p PQ ~E AlicU~aYE
AHD RELIAAIf.. ANY pl;~ttRi.PAN~I~ I.-fTutEEN ~~f pR^w1INC AMd TWE AtTUAt al~~ C4NbmONS
ABE THE SAI,F, R~:4rnNS~~IlI1Y ~F Tt~E t~IEHT,
crr~r of YELM
~tESIDENTIAl. BUILDING PERMIT APPLl~'' ~~TION FORM ~~SLJ
Project Address:,L~~,~/~~"''~~~,~ _ I~~r.G~ #: u~o7~ /~
Subtiivisiar~ /~.~ ~ (~ Lot #: ,7-
S ~ Zoning; =~ ~ .~.fi(
_J
New Construction a Re-Model / Re-Roof /Addition u Home Uccupatian Sign
U Plumbing U Mechanical U Mobile /Manufactured Home Placement U Other
Project Description/Scope of Work: .,~.Pr'AG (~ ~~-~~+'rc~ex ~ ~ Q S,~ ~ Q
-=r-
P~~e~t v~i~e:_~ZS~' : 9S~
Building Area esq. ~~ ~ ~ Floor ~'~ Floor Garage Deck
Basement Carpart~patio ~
# Bedrooms,,,,,,, # Bathrooms,,,, ~ieatin . A HER or ELECTRI i
9 C {C role Cne~
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
GENERAL CONT'RACTC?R __ _ TELEPHONE .
ADDRESS EMAIL
CITY sTATE,~....r.~...zlp FAx
CONTRACTOR'S LICENSE # :tom P DATE~CITY LICENSE #
PLUMBING CONTRACTC7R G~ , ~ TELEPHC~NE~~S~. ..~.~ ~ g ~~~
ADDRESS f ~~ ~ ~ EMAIL
CITY ,~~::~ ........STATE Gc~IP G~ ~ FAX ~~". ~ -~ ~_~
CONTRACTOR'S LICENSE # _~____-_ EJCP DATE~CITY LICENSE # ~~~.
MECHANICAL CQNTI~ACT R ~~`f ~ ~ r ;,..TELEPHONE ~zS ~
~, ~'~`
ADDRESS ~ f~7 ~ EMAIL _
CITY STATE cZIP ~'~'C .~" ~ 1=AXE ~ ~' ~--~
CONTRACTOR'S LICENSE # EXP LATE CITY LICENSE #
--- ........r.
CORY of mitigation agreement with Yelm Community Schools, if applicable.
~~
i hereby certify that the above i~`ormatinn is Cornea and that the construction on, and the occupancy and the use of the
above described property will be in accordance with the i~aw$, rules and regulaUona of the State of weshingtcm and the
City of Ye1m,
Applicant's Signatur+~
Qwner I Contractor ! C?wner's Agent !Contractor's Agent
Date
Please circle one.j
All permits are non-transferable and will expire if work authnri~ed by such permit is not begun
within 1~0 days of is:~uance, or if work is~ suspended or abandoned far a period of 1~a days
I05 Yetm Avenue West
PQ $ox ~ 79 ~3~+Dj 45~-3835
Yeim, WA 985gfi ~360~ X88-3r~~ FAX
wruru.Ci.yeYn,.r~a.ue
ARCHITECT NGINEER C,°~ ~ ICENSE #
ADDRESS ~ ~ _~..~'._~...~.~.~.~,
EMAIL
CITY ,~ STATE SIP f c~ TELEPHONE ~ 2~. ~ ~-~ ~~
_.~