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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: Evergreen State Builders
Permit No: BLD-05-0501-YL
Issue Date: 03/22/2006
(Work must be started within 180 days)
Receipt No: 41198
Address: P.O. Box 39753 City: Lakewood
Property Information:
Site Address: 14847 89th Ave. SE
Assessor Parcel No. 37540000900 Subdivision: Buckhorn Estates
Contractor Informatoor-:
Name: Evergreen State Builders Contact: Medina, Ed
Address: P.O. Box 197 City: Lakewood
Contractor License No: EVERGSB980P6 Expires: 10/02106275
Project'Informations
Project: Buckhorn Estates
Description of Work: 221112 SFR, Lot 9
Phone: 253.475.6622
State: WA Zip 98499
Lot: 9
Phone: 253-475-6822
State: WA Zip: 98499
Business License:
Sq. Ft. per floor: (1st) 1071 (2nd) 1140 (3rd) 0 Garage 434 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 -----------
1,562.71 -----------
993.75 -----------
568.96 -----------
5.6000 -----------
101.6000 -------------
$1,000
Building Plan Review 660.24 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 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
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
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
Fire District Impact Fee 571.32 0.00 571.32 0.2160 2,645.0000 square foot
TOTAL FEES: $8,563.52
Applicant's Affadavif:
OFFICIAL USE ONLY
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of # Sets of Prints:
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor, I futher certify that I am currently
registered in the State of Washington. `Final Inspection:
Dat .
Signature~~ii`~ Date "~.~ ~~
Firm ~~'~ y~
03/16/2606 14:46 253234313 CA5 RES NWAF TDM PAGE 03
L,pT 3
EZTERGREEN STATE BUILDERS
HTICREIORN SBTATPS
1484? 89t)n AVFSVVE 5OU'L~LSAST
TRUItSTON COLJNTI'X1 WA
PARCEL ~TO.3?54000900
89th AVE. SE ~~ ~`~` ~~
~~
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~j 2 OS CA5CA E REST EN IAL DESIGN, INc. 9GAL~ I' 201
Yhio Dfl~WINp 16 U~sED ON CLIENT--'iOVIDED INCORIn~TWN REvpEsENTEO TO AC nreuR~lE
•NP gCI.IANU. ANY ~I:.flRvn Nf.•Ir ?ETwEtN iNli ~finWlwC+ nNG TNC Atlllwl, fi1Tl fnNM11flNR
AkE 7Nf. SOIF p/,RppN$IRILriV M TIIE f.IICNT.
59 39vd c13Q1If13 1S Nd3~19~13f13 L~t9SLV6S~ 9b=5t 999Z/Lt/69
~~p4 TIiF"~ CITY OF
YELM
YePm, WA 98597 RECEIPT No. 41197
360-458-8403
RECEIVF~Q**EIGHT THOUSAND SEVEN HUNDRED FORTY SEVEN DOLLARS & 93 CENTS
~ ~5g2-
RECEIVED FROM DATE REC. NO. AMOUNT REF. NO.
EVERGREEN STATE BUILDERS 03/22/06 41197 8.747.93 CHECK PENDING
P.O. BOB 39753
LAKEWOOD WA 98499 BUDGETARY .
BLD-05-0500-YL
LOT 8 BUCKHORN ESTATES
JANINE
PERK 1625.43.PLAN686.74.MECH78.25.PLUM118.SEWINSP145..WTERU1500..WTERU1500.
WTHET300..WTDEP40..SEWDEP50..TRAFF757.50.SEWERULID2847..STFEE4.50.FIRE595.51
o~~f ~"~ '~ CITY OF
d YELM
P.O. Box 479
Yelm, WA 98597
360-458-8403
RECEIPT No. 4119 8
RECEIVFQ„*EIGHT THOUSAND FIVE HUNDRED SIBTY THREE DOLLARS & 52 CENTS
RECEIVED FROM
EVERGREEN STATE BU 3
P.O. BO% 3 ~~
LAKEWO WA 98499
BLD- -0501-YL
LO 9 UCKHORN ESTAT
DATE REC. NO.
03/22/06. 41198
BUDGETARY
AMOUNT
8.563.52 CHECK
1158 a-
REF. NO.
PENDING
JANINE ~
PERH 1562.71.PLAN660.24.MECH78.25.PLUM125..SEWINSP145..WTERU1500..WTHET300.WTD
EP40..TRAFF757.50.SEWDEP50.,SEWERU2769..STATFEE4.50.FIRE571.32
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_.. .. R__ E,S~_ENTIAL 6UILDING PER1YIf~T~A,P~PIt+CA_T1GIN FORM
Project Address~,~/_ ~ ~i37i+~' ~~ Percet #:.r ~~~~~
n, ~ ~ _
5ubdlvision:_~C~`?0-~/? .425 Lot#:_~_,___ Zaning; ~~ ~~ ~ ~
/~ ~~
}'New Construction u Re-Model I Re-Roof !Addition U Home Occupation Sign ~p ~
U Plumbing U Mechanical U Moblle /Manufactured Home Plaotrrrtent u Other ~j, '~„~..
Project DescriptiorJ cops of Work: ~P~ !fir r~~ T_ ~ ~
Pruned value: ~.?7D- ~~~ T ~j
Building Ares (sq. R) 1'" Fbor,~,7/ 2nd Flaor~/~D Garage _~"~~ Deck ~ i~
r ~,~ ~~ . Basement Carport Patio
# Badrvoms~ # Bathrooms ~•c_S` Heating~THER or ELECTRIC (C~rcle One)
Are there any environrnvrttally sensitive areas located on the parCO1? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: % ~ ~
ADDRESS ~~ ~ ~ J EMAIL ~ ~ ~,~
C17Y STATEGti' 7JP ~9 TELEPHONE _ _ s'_ _ 7S -~ ~~ ~
ARCHITECT/~NGINEER P~ V ICENSE #
ADDRESS //4vi -Sv v"t EMAIL
L CITY~~ Pl STATE ~-C _ZIP ~ O' TELEPHONE f~S3 ~ ~y- .~17n
GENERAL CONTRACTOR ~ C/itaLoCr 5 O(.C.lc.l~~ TELEPHONE
ADDRESS EMAIL
CITY ~ STATE ZIP FAX
CONTRACTOR'S LICENSE # ~ ~ .~' -~ ~ EXP DATE 07 CITY LICENSE #
PLUMBINGCONTRA T i? _,c.l? flt.P'~ LEPHONE~~5~7J..~7 '~oQ
ADDRESS f S/~ E:MAIL
CITY lGfCy~'dl,a. - -STATE~Z1P FAX l'S~~3~ ~ -
CONTRACTOR'SLICENSE # EXP DATE CITY LICENSE #
~ MECHANICAL CONTRACTO •/ TELEPHONE ~ _S3 C~
ADDRESS 55 iSc c/~ ~-~ -- EMAIL
cITY P STATE 7.11_; ~~ FAX
CONT CTOR' LICENSE # EXP DATE CITY LICENSE #
Copy of mitigation agreorrtent with Yeim Community Schools, if applicable.
1 hereby oartiry tlNt the above irAorawtlon k cor*oal snd chat lira corKthlctkll on, mrd the oeoupency and the vex or t)n
above ~iveerlbed propsMy wIU De In accordw~cs wMh the laws, ralea ind regulatloh- ar the Stets ar Washington and the
~ d~~ /~ ~ 6
p lioa~nt's S~~rm
Owner /Contractor 1 Owner's Agent /Contractor's Agent (Please cirzle one.)
All permits ars non-tran6fer~able and wtil expire if work authorized by such Hermit is r~ot begun
within 180 days v! its~susnce, or ti worst is suspended or abandoned for a period of 1 BO days
105 Yelp. AvenueWsar (3io) IS8.,783!
Pd 8os 179 (Si0) 1~R 111I FAJif
Yelrrr, Wi! 9BS97 m.vru.ci tielet.Waw
b9 39Cd ~13mIf1S 1S N33t19a~f13 L~I95Lb~S~ 9b ~ST 999E/LZ/S9
FROM :YELM SEWER DEPT.
FAX N0. :360-458-8166 Sep. 12 2006 09:44AM P1
O~~g xH~ p~
~~, FA.X TRANSMISSrON
~.~~~ C1TY OF YELM
W.,.HfNOTON P.O. BOX 479 - 931 NP ROAD ~NE
YELM, WA 98597
v -84 71
~ 3d0-4S8
FAX 36Oµ458-816f
FAX#:
From: ~j~uQ ~
Subject: ~~ ~ 5 ~
CC)MMENTS: L ~ i
DATE: ~ •- /,~ ~. D ~;
PAC7ES: j ,including this
Cover sheet
~~,oa~~o.ao
** if you do not receive ttll copies or any copy is not le~iblc, please call (360) 458-84] l
as sc~or~ as possible.