BLD-05-0501City of Yelm
Applicant
Community Development Department
Builtling Division
Phone: (360) 4688407
Fax: (3601468-3144
Permit No: BLD-05-0501-YL
Issue Date: 03/22/2006
(Work must be startetl within 180 tlays)
Receipt No: 47798
Name: Evergreen SUte Builtlero Phone: 263.475.fi622
Atltlress: P.O. Box ]9763 City: Lakewood State: WA Zip 98199
Property_Information:
S4e Atltlress: id81789N AVe. BE
Assessor Parcel No. 37510000900 Subdivision: Buckhorn Estates Lot: 9
Contractor Information: __
Name: Evergreen State Builtlerm Contact: Medina, Ed Phone. 253475-6822
Atltlress: P.0. Box 197 Ciry: Lakewood Slate: WA Zip: 98499
Contractor License No: EVERGSB980PB Expires: 10/021062]6 Business License'
Project lnfortna0on:
Project: Buckhorn Estates
Description of Work: 221112 SFR, Lol9
Sq. Ft. per floor: (1st) 1071 12ntl) 1140 (3rtl) 0 Garage 434 Basement 0
Heat Type (ElecMC, Gas, Other): GAS
Fees: _ _ --~
Item Item Fee Base Amt Unil Fee Unit Rate No. Units Unit Desc
Builtling Permit 100-SOOk 1,562.]1 99375 568.96 5.6000 101.fi000 b1,000
Builtling Plan Review 660.24 0.00 0.00 0.0000 0.0000
Mechanical Peemit 76.25 0.00 0.00 0.0000 0.0000
Plumbing Permit 125.00 20.00 105.00 7.0000 15.0000 fiAme
Sewer Inspection 145.00 0.00 145.00 145.0000 1.0000 ERU
Water ERU 1,500.00 0.00 1,500.00 1,500.0000 1.0000 ERU
Wafer Meter (SFD) 300.00 300.00 0.00 0.0000 0.0000
Wafer Deposit 40.00 40.00 0.00 0.0000 0.0000
Trafrc Facilities Charge 757.50 0.00 757.50 750.0000 1.0100 Peak PM Trip
Sewer Depasil 50.00 50.00 0.00 0.0000 0.0000
Sewer ERU (LID) 2,769.00 0.00 2,769.00 2,769.0000 1.0000 ERU
Slate Building Fee 4.50 4.50 0.00 0.0000 O.000D
Fire District Impact Fee 571.32 0.00 571.32 0.2160 2,645.0000 square root
TOTAL FEES: 68,663.62
I certify that I have read and examinetl the infortnalion contained within the application antl know the same V~ ~ ~..~... V~~ ..~~.
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of p Sets of Prints:
Yelm regulations indutling those governing zoning antl land subtlivision. and in addition, all covenants.
easements antl restridiens of revere II applying as a contractor, I father certify that I am currentty
regisleretl in the State of Washington. Final Inspectlon:
Signature- ~~~ ~~ Date
Firm `{
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LOT 9
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PAGE B3
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o
° '"` ~l CITY OF ~
~ YELM
YePm, WAx98591 RECEIPT No.41 197
360-058-8403
RECEIVF~4..
EIGHT THOUSAND SEVEN HUNDRED FORTY SEVEN DOLLARS & 93 CENTS
1151i2-
RECEIVED FROM DATE REC. NO. AMOUNT REF. NO.
EVERGREEN STATE BUILDERS 03/22/06 41197 8,747.93 CHECK PENDING
P.0. BO% 39753
LAKENOOD XA 98499 BUDGETARY
BLD-05-0500-YL
LOT 8 BUCRHORN ESTATES
NTMET300.,WTDEP40.,SENDEP50.,TAAFF757.50,SEWERULID2847~,STFEE4 .~50,FIRE595.~51
a""~~ CITY OF
YELM
velm°,wRn"sessT RECEIPT No. Q 1 19 8
360-4588403
RECEIVF~Q ..EIGHT THOUSAND FIVE HUNDRED SI%TY THREE DOLLARS & 52 CENTS
I I58 ~
RECEIVED FROM DATE REC. NO. AMOUNT REF. NO.
EVERGREEN STATE BU S 03/22/06 41198 6,563.52 CHECE PENDING
P.0. BO%
LA%EMO MA 98499 BUDGETARY
BLD- -0501-YL
LO 9 UCEHORN BSTAT
JANINE
PERH 1562.71,pLAN660.24,HECH78.25,PLUH125.,SENINSP145.,NTERU1500.,
EP40.,TRAFF757.50,SENDEP50.,SENERU2769.,STATFEE4.50,PIRE571.32
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Project Addreas;[J~j ~jyL.~r SE )tercel it_p... :~~~~
i
sup~/dl-raim: Ruckha/I1.~S6~fest.a#: `' zoning: z !2 ~ ~~
tYNew CmsWGion u Ro-MOdel I RaRaof! Addison U Home Occupation Sign ~p Q(w;
U Plumping U Mechanical U Mobllel Manu(aclured Home"Placement U IJther /> L
Project DeaerlptpNScvpe aWork: •SP~d ~~ ~P ~FCLr~cc.er./ .l~Q-~((.~.~CC~ '~~ ~Q
AA 7 ~
Project
Building Arne (ap. A) t' FborlO ~ 2'" Floor//5vD Garage ,$ ~ ~5r Deck
`~{5 4~ • Beaenrent camort_Petio
# Bedrooms # Balhrpdma Z-~ Hea6ng/tanyyTHER aELECTRIC (CiltAe One)
Ne discs any emironrnerdally sensipve areas located an l~ha D~arcel? M yea, a
wmDleted erwironmerdal checklist must accompany permd application.
~S,O~d
BUILDING OWNER NAME: '~ - _ .Or-
ADDRESS ~lF/S-/(! _ _~ l.sT ~.t7 FMAIL Sbr ii P~7~~Sfi2~
CITV~ STATELCiI LP49 TELEPHONECZSx~ 7S ~i (o2L
Copy a<mipgation agreement with Yelm Community Schools, ~ apPlitaple.
1 hweb) nrwp IM 11r aDOw MaMbn k correct rntl thM tlw caMDaclbl on. ultl e~ accapert) area vl. vsc a eA
rDOV~ tl1lCra.e ymp~ny Mla Dtl In KCOftlM W Mall aN IOr4 rV101 illtl n1aYIreOM OI alb alYw OI wMtlDlalpl, Blltl mr
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nppjicanzs slgltaturo Date -
Owner I Contractor I Owner's Agent I COrIVaCIOf 8 Agsnt (Pka58 Grote one.)
All permits ate rton~ransterebN aM will eaptro if work authorized by such pemdl is rot begun
wflhln 1bg dayz Of 16auence, or U wink ie suspended or abandoned for a Period d 180 days
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FROM :YELM SEWER DEPT. FRX N0. :360-458-8166 Sep. 12 2006 09: 44RM P1
FAX TRANSMISSION
CITY OF YELM .
P.O.. BOX 479 - 931 NP ROAD NE
~\ \ YELM, WA 98597
j~ V 360-458-8411
Ivy FAX 360-458-8166
TO: G2 cKEN DATE: 9-/~~0~
FAX#: PACES: (,including this
Cover sheet
From: ~,9N0 ~'
Subject: 1-IoU6C FWA~/t3uCKHo~/v ~5'T.
COMMENTS: Ld 1 9~ 1 v`Ll ~ h 9'n` qv~. S. C•
6~ ~ 0~ ~(~ . ~~
** If you do not receive all copies or any copy is not legible,"plen.ge cull (360) 458-8411
as soon as possible.
CITY OF YELM -BUILDING DEPARTMENT
RESIDENTIAL CERTIFICATE OF OCCUPANCY
Building Address
Owner Name
Owner Address
Building Permit Number BLD-05-0501-YL Plan Number
Areas
Special
Building Official: G. Carlson Date: September 12 2006
This structure is in compliance with the International Residential Code (Chapter
51-51 WAC) as adopted by the Washington State Building Code Council pursuant
to Chapters 19.27 and 70.92 RCW, effective July 1, 2004