BLD-05-0145
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C\1Y Of YELI\II- BUILOING OEP AR11\11ENl
RESIOEN11AL CER11flCA1E Of OCCUPANCY
Building permit Number
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Building P-ddress
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Plan Number
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owner Name
owner A.ddress
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special conditions
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RemarKS.
A.reas \nspected
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Bui\ding OHicial
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1t\IS struclUre ts in compliance with the IntemationalResidential Code (Chapter
51-51 \fliP-C) as adopted bY \tle \fIIashington State BUIldIng Code councIl pUlSuant
to Chapters 19.21 and 10 92 RC\fII. effect..e JUly 1. 2004
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CITY OF YELM INSPECTION LOG
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FROM YELM SEWER DEPT
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FAX#'
From Rri;.JDY
FAX NO. 360-458-8156
Nov 07 2005 04 48PM Pi
FAX TRANsrvnssloN
CITY OF YELM
POBOX 479 - 931 NP ROAD NE
YELM, W A 98597
360-458-8411
FAX 360-458-8166
DATE II 7~[)7J-;
PAGES. ) , mcluding this
Cover sheet
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COMMENTS '-0 \" 3/ ~""D -s GOA Te.."')
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** If you do no! receive <111 copies or any eopy is not legible, please call (360) 458-8411
as SOOI1 as possible.
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0145-YL
Issue Date. 05/18/2005
(Work must be started within 180 days)
Receipt No
36766
AppUcant:
Name: Evergreen State Builders
Phone:
253-475-6622
Address. P.O. Box 39753
City' Lakewood
State: WA Zip 98499
Prop~rtylnforlnation:
Site Address. 15833 Yelm Terra Way SE
Assessor Parcel No. 85840000500
Subdivision. Yelm Terra
Lot: 5
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 Information:
Project: Yelm Terra
Description of Work: Plan 1530 S/2, Lot 5
Sq. Ft. per floor (1st) 1530
(2nd) 0
(3rd) 0
Garage 582
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 1,069.91 993.75 76.16 5.6000 13 6000 $1,000
Building Plan Review 695.44 000 0.00 o 0000 o 0000
Mechanical Permit 7175 0.00 0.00 0.0000 0.0000
Plumbing Permit 111 00 2000 9100 7 0000 13.0000 Fixture
Sewer Inspection 145.00 0.00 14500 145 0000 1 0000 ERU
Water ERU 1,500 00 000 1,50000 1,5000000 1 0000 ERU
Water Meter (SFD) 300 00 300.00 0.00 o 0000 0.0000
Water Deposit 4000 40.00 0.00 0.0000 o 0000
Traffic Facilities Charge 757.50 000 757.50 750 0000 1 0100 Peak PM Trip
Sewer Deposit 5000 5000 0.00 0.0000 o 0000
State Building Fee 450 4.50 0.00 0.0000 o 0000
SewerERU 5,41700 000 5,41700 5,4170000 1 0000 ERU
TOTAL FEES. $10,162.10
Applicallt's AffCldavit:
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 ttI1t" ~~ Date.,s-:- /J ~
Firm ~S4
# Sets of Prints.
Final Inspection:
Date:
By'
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PAID
MAY 1 8 Z005
CITY OF YELM
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: Evergreen State Builders
Address. POBox 39753
Project Information:
Project: Yelm Terra
Description of Work: Plan 1530 S/2, Lot 5
Site Address. 15833 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 420120-344-85-00
Sewer Deposit 742402-389-01-00
State Building Fee 160001-386-00-00
Sewer ERU 802412-343-50-01
TOTAL FEES
Permit Fees Schedule
Permit No BLD-05-0145-YL
Phone:
253-475-6622
City' Lakewood
State. WA Zip 98499
Assessor Parcel No. 85840000500
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
-------------
1,069.91 993.75 76.16 5.6000 13.6000 $1,000
695.44 0.00 0.00 0.0000 0.0000
7175 0.00 0.00 o 0000 0.0000
111 00 2000 9100 7 0000 13.0000 Fixture
145.00 000 145.00 145 0000 1 0000 ERU
1,500 00 0.00 1,500 00 1,5000000 1 0000 ERU
300 00 300 00 000 o 0000 o 0000
40.00 4000 000 o 0000 o 0000
757 50 000 757 50 750 0000 1 0100 Peak PM Trip
50.00 5000 000 o 0000 o 0000
450 450 000 o 0000 o 0000
5,41700 000 5,417 00 5,417 0000 1 0000 ERU
$10,162.10
il!~~~iW~1IfJi:,"i:~I~~~II~~ml!li~~iIIDi"J!!JIlI!lED,llIIl-I'I'U Il!i~~" . .
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1..~r~l~~'i~~~MlJiW~~~~~_illlIIl~If~~~!of*!eR
F{ECEIVED '
****TEN THOUSAND ONE HUNDRED SIXTY TWO DOLLARS &/10 CENTS
I
11ECEIVED FROM DATE REC ND
EVERGREEN STATE BUILDERS 05/17/05 367'6
PO BOX 39753 \
LAKEWOOD. WA 98499 BUDGETARY
BLD-05-0145-YL \
---"~TE _15B~ YELI'l TERRA NY S~ L05__DHNI\___,"_~___
BLDPRl1TI069 91. PLNREV695 44. HECHPRll'l'71 75. PLNBPRHT1 . :;;/INS145.
1 500. W / If T R .3 (I (1. i'J IDE P 4 0. T H A F F 7 5 -; ') O. S / DE P 50, S 'I' FEE 4 5~), S / E R U 5 4 1 '1
fX,~ IHlf~;;\~: Clfl'Y OF
II!{;~~I YELM'
/' ,[~" PO 130x 178
If. . ''''.'/~ \'8Im, WA 9B597
~,~~,.., 360-458-8403
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RECEiPT No 3 6 7 66
~"
\
AMOUNT
PENDING
REF NO
10.162 10 CHECI<
Vl/ERU
I: - Q
RECEIPT No 36 7 6 7
FlECEIVED
.***TEN THOUSAND TWO HUNDRED SIXTY SEVEN DOLLARS & G9 CENTS
F1ECEIVED mOM
DATE
REG NO
EVERGREEN STATE BUILDERS 05'17/05 36767
PO BOX 39753
LAKEWOOD. WA 98499 BUDGETARY
BLD-05-0144.-YL
SITE 157b9 YELM TERPA WY SE L14
AMOUNT
REF NO
1C1.267 69 CHECK
PENDING
.~__.______n ---[tl A-N-A-- -- ________________n_._____
BLDPHH1301 19, PLNREV549 75, l1ECHPRJ1T84 75, PLHBPRIIT1113. ::J/INSP145, \'l/ERU
lS0(). 1^,,/HTH300. W/DEF4(l. TRAFF7,]7 5(1. S,DEP::in, STFEE4 ':i~j. S/EHU5417,
~~~ CITY OF
;;;/ 'e YlE~ lM
o'L..."'-;"~-:-~~ _ .i., _
/'"""......- ....
/.(r, '::::..- PO 130)1 479
[... //L.~-.J . ldll. I WA 98597
I[!"'~ 3130-45R-840:i
REClE~PT No.3 6768
RECEWE::D
****TEN THOUSAND TWO HUNDRED SIXTY SEVEN DOLLARS & 63 CENTS
FlEl.,EIVf"D FFlOM
DArE
REC, NO
EVERGREEN STATE BUILDERS 05/17/05 36768
PU BOX 39753
LAKEWOOD. WA 984Q9 BUDGETARY
ElLD - 0 5 - 0143 -. YL
SITE 15845 YELH TERRA WY SE L0~
AMOUNT
F1EF NO
1<1.267 69 CHECK
PENDING
_._-~,---_._----~- __m_______ 0-:1--A-1'.J.j.\~------~---~-~-___
B L D P R 11 T L~;) .1 1 q. P L H E V 5 4 '3 -;'S. HE C H P R l'f'r S ~ 7 5, P L 11 B P R H T 11 8, ,~/I N S F' 1 4 5 , l^iI E R U 1 5 () ()
W/HTR300. W/DEP40. TRAFF757 50, S/DEP50, STFEE4 50. S/ERU5417.
FH::CEIVf::D
RECEiPT No 36 7 6 9
HECEIVED FHOlvl
REG NO
****TEN THOUSAND FOUR HUNDRED TWENTY EIGHT DOLLARS & ~1 CENTS
REF NO
DATE
EVERGREEN STATE BUILDERS 05/17/05 367G9
PC) BC\X 3975.3
LAKEWOOD. WA 98499 BUDGETARY
BLD-'05"~)14..-'{L
SITE 1575~ YELM TERRA WY SE L89
.--'-~-
_'D_"_'D-~-r'
-------~--~
AMOUNT
10,42.<3 91 CHECI(
PENDING
----
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Yelm School Distrlct
ATTN SUSAN CROY
PO BOX 476
YELM, WA 98597
360-458-1900
Sold to 16755
EVERGREEN STATE BUILDERS LLC
56622
BUILDERS LLC EVERGREEN 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
SubTotal
6,844 00
Total Due
Check
6,844 00
6,844 00
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----------
Thank you.
PLEASE KEEP THIS RECEIPTI I!
o
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LOT S
EVERGREEN STATE BUILDERS
YELM TERRA
15833 YELM TERRA WAY SOUTHEAST
YELM, WA
WATER LINE - - Y~LM - TERRA - AVE~ - SE - - --
SEWER LINE -~--=-r---~---~---~g- - - ~r-~
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~ --170~480/~ 50 ~
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SIDEWALK - -60.00' - - ~l'
CURB
1 05th AVE SE,
SEW E R LI N E ---=-=-~--=- =--=-=- ::: ~--=-= -=- - -=-=- - -=- =--=-=- ~ ~ -- - =-=
MOV~D___
--.-- s-IJ io ~-'
I -~_.
~~ SITE PLAN
,
eJ 2005 CASCADE RESIDEN TIAL DESIGN, INC
@
NORT~
SCALE I' : 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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ProjectAddress~3 'Ie/-" ;?;ii'~'<A AMI,!, *-Pareet#. /...5 Yo Z
Subdivision: Yefh1 /.-€rrvt Lot#. S- Zoning; ~-flg Ii} -+t-.//h11 /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:~ fJ Ie -raMI '3 f.I!. &t ~I-I CL /
Project Value. "2' (!) ~ 9S0
/
Building Area (sq. ft) 1st Floor/S'l t!) tld Floor Garage -57 Z- Deck
Basem~nt Carport Patio 2../6-
# Bedrooms .3 # BatA~06ms :z..... Heatin~OTHER or ELECTRIC (Circle One)
Are there any environmentall)1 sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER NAME. ~ &J~/~~ ~
~~m~~5 - ~~TE . ZIP ., ~~~HONt LL-'f fs-~~2~
ARCHI1ECTIENGlNE~ $."~ =..tlICENSE #
ADDRESShl_ ~;? 'I?~ EMAIL&rI1:Gi;L
CITY72lCl!rila STATE:t~ ZlP9x~z TELEPHONE(-63J 2ffY -{3/76
GENERAL CONTRACTOR \~ a-S trltJ/LV TELEPHONE
ADDRESS EMAIL
CITY STATE FAX
CONTRACTOR'S LICENSE # Ev.i EXP DA T . CITY LICENSE #
PLUMBING CONTRA!;rOR..J
ADDR~~~-<J1~
CITY fa . STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX Z<~~~-q?~
EXP DATE CITY LICENSE #
MECHANICAL CONTHACT9R .SPtt'N(_~/ #e:Ar7 #'7 TELEPHONE ZS.J 6 76'~.? J$o
ADDRESS5szG /..;"''V~ :f{r ~;-k A, EMAIL
CITY ~,Yc?#~ STATE tl'A!-"~ ZIP ?~? 7S"" FAX 'ZS'J #7.5"- p'z;fS-
CONTRACTO 'S LICENSE # EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable
I hereby certify that 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 laws, rules and regulations of the State of Washington and the
City of Yelm.
/~__~ (~/.?-CJO
Applicant's Signatun~ Date
Owner I contractor(~ Contractor's Agent (Please circle one.)
AU permits are non-transferable and will expire if work authorized by such permit is not begun
within 180 days of is!mance, or if work is suspended or abandoned for a period of 180 days
105 Yelm Avenue West
PO Box 4'/9
Yelm. WA 9859'/
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wo.ua