BLD-05-0143
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Building I>.ddress
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plan Number
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owner Name
Owner I>.ddress
Building permit Number
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RemarKS
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1>.\1 Code reauired
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f>,feas Inspected
special conditions
Date
Building OHicial
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. . \ ternational Residenr..1 Code (cnapler
1nis sllucture is in compliance ~\:.~~; I~n state Building Code council pursuanl
5 ~ -5 ~ \NI>.C) as adopted b'J t2n7e d 70 ~2 RCW effective lUW \. 2004
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, .ui' 'y'ELM SEWER DEPT
FAX NO. 360-458-El166
Nov 14 2005 10 SlAM Pl
FAX TRANSMISSION
CITY OFYELM
1:
P.O. BOX 479 - 931 NP ROAD NE
YELM, W A 98597
360-45 g-841 1
FAX 360-458-8] 66
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PAGES: ( , including this
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SubJect- Hou 5(:: r- \AJAC lYE Crn 'TE{(I(/;'
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** If you do not r~celve all COplCS or ~ny copy IS not legIble, please call (360) 458-8411
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CITY OF YELM INSPECTION LOG
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PROJECT
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ADDRESS
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PERMIT NUMBER
Date
WALL
Q 6"
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W .\LL REBAR / Date ~ J;;-,"6
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FOOTING
~ 12"
B"16"
o other
o reqUIred \'ents
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'7<~ fOOTI~G REBAR
~4( C0!"!~~e!'~s
SET BACkS Date
Front Z,O
Rear 2'-/
Side 'FlarTh.lOg
Slde
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CO'lBl;\[D FRN\lEI EXTERIOR SHEAR WALL I\SPECTIO~
HF old downs :} /. 4~' 1> GShe~pr NadIng XC 5'f~J'/ ,
rame /:.... t..W" I J/I as ropane~ ] "'~I r
PlumbIng }' ~ )JIf Mechanical,
Com m en ts Ct.""" \:;:) \cc>>~"
I\Sl LA TION
J Gas
o Foam and Seal
~ Electnc
=:J Vapor barner
n Other
n p\,-\
Comments ()A,v ~ P:f
SHEET ROCK/SHEAR \\' .\LL ~AIL
Comments
OTHER
Comments
FINAL
o Sewer Final
o Address
Q Electrical
o InsulatIon
o Cml Final
o Site Dramage
o Landscape Final
CJ Slde\\alk.
o C of 0
Comments
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0143-YL
Issue Date 05/18/2005
(Work must be started within 180 days)
Receipt No
36768
App!ical1t:
Name. Evergreen State Builders
Phone:
253,475.6622
Address. POBox 39753
City' Lakewood
State: WA Zip 98499
Propertyl.nf()rmation:
Site Address, 15845 Yelm Terra Way SE
Assessor Parcel No 85840000300
Subdivision: Yelm Terra
Lot: 3
Contractor Information:
Name: Evergreen State Builders
Contact: McCullem, Tom
Phone: 253-475-6622
Address. P.O. Box 39753
City. Lakewood
State: WA Zip: 98499
Contractor License No EVERGSB980PB
Expires, 10/02/06275
Business License: 1042.0
Project Il1formati()n:
Project: Yelm Terra
Description of Work: Plan 2200 12A Lot 3
Sq. Ft. per floor' (1st) 1172
(2nd) 1028
(3rd) 0
Garage 480
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-S00k 1,301 19 993,7S 307 44 S,6000 S4 9000 $1,000
Building Plan Review S49 7S 000 000 o 0000 o 0000
Mechanical Permit 847S 000 000 o 0000 o 0000
Plumbing Permit 118,00 2000 98.00 7 0000 140000 Fixture
Sewer Inspection 14S,00 0,00 14S,00 14S,0000 1 0000 ERU
Water ERU 1,SOO 00 0.00 1,SOO.00 1,SOO,0000 1 0000 ERU
Water Meter (SFD) 300 00 300,00 000 0,0000 o 0000
Water Deposit 4000 40.00 000 0,0000 o 0000
Traffic Facilities Charge 7S7,SO 0.00 7S7,SO 7S0 0000 1 0100 Peak PM Trip
Sewer Deposit SO,OO SO.OO 000 o 0000 0,0000
State Building Fee 4,SO 4,SO 000 o 0000 0,0000
Sewer ERU S,417 00 0.00 S,417 00 S,417 0000 1 0000 ERU
TOTAL FEES $10,267.69
AppRc:...nt's Affad.."i!:
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
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 r ,.JIA~ _ ~ Date ~ A1I'..~
Firm ~S~
# Sets of Prints,
Final Inspection:
Date: fI-1 Y - 0 y-
By. -J,<:tJ
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
PAID
MAY 1 8 Z005
CITY OF YELM
Permit Fees Schedule
Applicant:
Name, Evergreen State Builders
Address. POBox 39753
Project Information:
Project: Yelm Terra
Description of Work: Plan 2200 /2A Lot 3
Site Address. 15845 Yelm Terra Way SE
Fees:
Item Acct Code
Building Permit 100-500k 032001-322-10-00
Building Plan Review 100001-345-83-00
Mechanical Permit 032001-322-10-00
Plumbing Permit 032001-322-10-00
Sewer Inspection 805412-343-80-00
Water ERU 712401-343-80-01
Water Meter (SFD) 712401-343-80-01
Water Deposit 740402-389-00-00
Traffic Facilities Charge 420 120-344-85-00
Sewer Deposit 742402-389-01-00
State Building Fee 160001-386-00-00
Sewer ERU 802412-343-50-01
TOTAL FEES.
Permit No BLD-05-0143-YL
Phone:
253.475.6622
City' Lakewood
State: WA Zip 98499
Assessor Parcel No, 85840000300
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
-------------
1,30119 993,75 307 44 5,6000 54.9000 $1,000
549 75 000 0.00 o 0000 0.0000
8475 0.00 000 0.0000 0,0000
118,00 2000 98,00 7 0000 14 0000 Fixture
14500 000 145,00 145 0000 1 0000 ERU
1,50000 000 1,50000 1,5000000 1 0000 ERU
300 00 300.00 0.00 o 0000 o 0000
4000 4000 0.00 0,0000 o 0000
757 50 0.00 757,50 750.0000 1 0100 Peak PM Trip
50,00 50.00 000 o 0000 o 0000
4.50 4,50 000 0.0000 o 0000
5,41700 000 5,417 00 5,417 0000 1 0000 ERU
$10,267.69
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Ye1m School Distrlct
ATTN. SUSAN CROY
PO BOX 476
YELM, \1A 98597
360-458-1900
Sold to 16755
EVERGREEN STATE BUILDERS LLC
56622
BUILDERS LLC EVtkGREEN STATE
5516 75TH ST W #1
LAKEWOOD, WA 98499
# 5934 07 05/18/05
Reg #1 SalesPerson SUSAN
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJECTS
1 @ 6.844 00 6,844 00
CK ~09706 FOR YElM TERRA LOTS 3.5,14,& 8
9
SubTota 1
6,844 00
Total Due
Check
6,844 00
6,844 00
----------
----------
Thank you
PLEASE KEEP THIS RECEIPT' I!
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LOT 3
EVERGREEN STATE BUILDERS
YELM TERRA
15845 YELM TERRA WAY SOUTHEAST
YELM, WA
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SEW E R LI N E =-=-=- - ~ ~ = -=-=-= -=- - -=-=- - ~ ~~ --=-= ----=-=
ca~ SITE PLAN
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NORTH
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<9 2005 CASCADE RESIDENTIAL DESIGN, INC
SCALE \' = 30'
THIS DRAWING IS BASED ON CLIENT -PROVIDED INFORMATION REPRESENTED TO BE ACCURATE
AND RELIABLE, ANY DISCREPANCIES BETWEEN THIS DRAWING AND THE ACTUAL SITE CONDITIONS
ARE THE SOLE RESPONSIBILITY OF THE CLIENT
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Project Address:~o !4h 76'..e~ ~A," ~ ~ #. .,:?,?{ ~~/.....?
Subdivision: YeffYl 7erf'Pl Lot#~ Zoning; .,&l..fl.g /.[1 -ICVh1/I'j
~ew Construction U Re-Modell Re-Roof I Addition U Home Occupation Sign
u Plumbing u Mechanical U Mobile I Manufactured Home Placement U Other
Project Description/Scope of Work: ~ ~ Ie -raMI (:) ff &t duJ-1 CL I
Project valur!f ;;? 3~ 7,5(')
BuildingArea(sq.ft) 1stFloor//72... 2ndFloor/bZg Garage ~A't:> Deck
Basem"ent Carport Patio ;2/6
# Bedrooms-J.. # Battl~06ms..z..S- Heatin~OTHER or ELECTRIC (Circle One)
Are there any environrnentallx sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER NAME. '(/I~
ADDRESS _~3"Bi:; - EMAlL ...s;
CITY Lt::iAtJuYYJd STATE TELEPHONE
ARCHITECTIENGINEER.~"~ :="'AICENSE #
ADDRESS,b ~;2 ~ EMAILaU~"1
CITY7ZlClmJa STATE t'A/l Z1P9~>hz - TElEPHONE~?;Q 2x'l-,"f176
GENERAL CONTRACTOR \~ as trJ1J/'t..tr TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # e/4 EXP DA T . ~ CITY LICENSE #
PLUMBING CONTRAGJOR..J
ADD~~~-~~
CITY fa . STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX Z <~ s:;:(6 - 9~~
EXP DATE CITY LICENSE #
MECHANICAL CONTRACT9R .s,-A-e--/ ReAr;- #7 TELEPHONE Z5'!J S 70--.? J:Fc')
ADDRESS5SzG:. /.;"'.y~ :S'r ~...~ ..,rf, EMAIL
CITY"";;;lfc?#i?S STATE",..-? ZIP?J>.?7S-FAX-zS'J S7S-6'~~S-
CONTRACTO '5 LICENSE # EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable
I hereby certify thaI the above Information Is correct and that the construction on, and the occupancy and the use of the
above described property will be In accordance with the lawB, rules and regulations of the State of Washington and the
City of Yelm.
/~~ ..s-:-/3"~6-
Applicant's Signatur~ Date
Owner J Contractor (~ Contractor's Agent (Please circle one.)
All permits are non-transferable and will expire if work authorized by such permit is not begun
within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days
105 Yelm Avenue West
PO Bo" 4'/9
Yelm. WA 9859'/
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wa.WI