BLD-05-0144
~i~~~
crr'( Of '(ELtJI _ aUILOltlG OEP~R1tJ1Etl1
RESIOEtl11~L CER1IfIC~ 1E Of OCCUP ~tlC'(
Bu\\ding perm\t Number
~
~
~~
~5:l
~
Bu\\ding p.ddress
Owner Name
owner p...ddress
2200/2f>-
plan Number
Remar\t-s
---
1\\1 Code Reou\red
~
p.,reas Inspected
special conditions
None
oate
Building Oiiiciat
. . e Inle(OOllonol ResldenUol Code \ChOple,
1hlS swelu,e is in eOll1pllOnee :/.'Ih ~ Ion stale l>ulldlnQ Code CouncIl pUlSuonl
5~S' \Np...C) as adopted b'l \2"'7eo d~~n~2 RON, ellecllve JUlY ~,2004
to c",apters ~9. an
G. carlson
-~~~\@}
FROM ~~LM S~WER ,DEPT
FAX NO. 360-458-8166
Oct. 21 2005 03 35PM Pi
FAX TRANSMISSION
CITY OF YELM
P.O. BOX 479 - 931 NP ROAD NE
YELM, WA 9gS97
360-458-8411
FAX 360-458-8166
TO- &---It -
DATE: 10 - ;)./-0 ~
FAX#:
PAGES: , , including thIS
Cover sheet
From: ((p,IVD C(
Subject I-IoLl~E" F l,/JAY Yet-/')") Tt;:RRA
COMMENTS. LOT l<i) )f7(gq Yl:LM TaIlA W.A'f S*C,.
6'5-5/46 ,00
** If you do not receive all copIes or any copy IS not legible, please call (360) 458-8411
as soon as possible.
,- II
r
! f
, f!
I .:"
, ~I
"
h
1
/.'
~i
')'0
't:
~I
'\:
> ":~;
,
_I
j -'f
:It:
<.
(.
I
DATE,TIME
FAx NO /NAME
DURATION
PAGE(S)
RESULT
MODE
TRANSMISSION VERIFICATION REPORT
10/21 15 14
PUBLIC WORKS
00 00 19
01
OK
STANDARD
ECM
~fT
.<.
~fi!
TIME 10/21/2005 15 15 Jj
L~
! i
I
J
"
'r
IJ
j
f
!t!
q
: ij
I'
il'
.~
I IF.
I ,
ij
~ ')
~~
o
o
~I
~
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0144- YL
Issue Date. 05/18/2005
(Work must be started within 180 days)
Receipt No
36767
Applicant:
Name: Evergreen State Builders
Phone.
253.475.6622
Address. P.O Box 39753
City' Lakewood
State: WA Zip 98499
Property Information:
Site Address 15769 Yelm Terra Way SE
Assessor Parcel No. 85840001400
Subdivision: Yelm Terra
Lot: 14
Contractor Information:
Name: Evergreen State Builders
Contact: McCullem, Tom
Phone: 253-475-6622
Address. POBox 39753
City' Lakewood
State: WA Zip' 98499
Contractor License No. EVERGSB980PB
Expires. 10/02106275
Business License: 1042.0
Project Information:
Project: Yelm Terra
Description of Work: Plan 2200 /2A Lot 14
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 100-500k 1,301 19 993.75 307 44 5.6000 54 9000 $1,000
Building Plan Review 549 75 000 0.00 o 0000 o 0000
Mechanical Permit 8475 000 0.00 o 0000 0.0000
Plumbing Permit 118.00 2000 98.00 7 0000 140000 Fixture
Sewer Inspection 145.00 0.00 14500 1450000 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 o 0000
Water Deposit 40.00 4000 0.00 o 0000 o 0000
Traffic Facilities Charge 757 50 000 757.50 750 0000 1 0100 Peak PM Trip
Sewer Deposit 50.00 50.00 000 o 0000 0.0000
State Building Fee 4.50 450 000 0.0000 o 0000
SewerERU 5,41700 000 5417.00 5,417 0000 1 0000 ERU
TOTAL FEES $10,267.69
Applicant's.Affadavit:
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.
Signatu~~~
OFFICIAL USE ONLY
# Sets of Prints.
Date
~/7-tt:JZS-
F~n spection" .
Oat: '() ~
. ~
Firm
o
City ofVelm
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 2200 /2A Lot 14
Site Address. 15769 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
o
PAID
MAY 1 8 2005
CITY OF YELM
City' Lakewood
Permit Fees Schedule
Phone.
Permit No. BLD-05-0144-YL
State. WA Zip 98499
253.475.6622
Assessor Parcel No. 85840001400
Item Fee Base Amt
1,30119 993.75
549 75 000
8475 000
118.00 2000
14500 000
1,500.00 000
300 00 300 00
4000 4000
757.50 000
50.00 50.00
450 4.50
5,417 00 0.00
$10,267.69
Unit Fee
307 44
000
000
98.00
145 00
Unit Rate No Units Unit Desc
5.6000 54 9000 $1,000
0.0000 0 0000
o 0000
7 0000
145.0000
1,50000 1,500.0000
000 o 0000
000 o 0000
757.50 7500000
000 o 0000
000 o 0000
5,41700 5,417 0000
o 0000
14 0000 Fixture
1 0000 ERU
1 0000 ERU
o 0000
0.0000
1 0100 Peak PM Trip
o 0000
o 0000
1 0000 ERU
o
Yelm School Distrlct
ATTN. SUSAN CROY
PO BOX 476
YELM, WA 98597
360-458-1900
Sold to. 16755
EVERGREEN STATE BUILDERS LLC
56622
8UILDCRS LlC EVrRGREEN 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
----------
----------
Thank you
PLEASE KEEP THIS RECEIPTI I I
o
~!i~!"tWl!6_l~~~~13t~~W~~.,.""""..,.~"u
I rk<~,'=7:;'~:~{1 \crrv OJF - 0 - 0 I
i! '1 \~.\! Y E Lfv1f
I () i;rlX l',q ,. -767
It I .,,, \I'!I 'In,(l/ nECEIPT r'.io j 6
~=:=:~.:_~~':'::.u.~ ~,(;rl 11,(\ ,:110,j
II {!', i I Ii II
. ""n;u ['HnU:::ANU 'i'!r1O I/lINUHLD ...;IXT'r' SEVEN DOLLJ\PS [, h9 CENT::-
i il '.1 llil !! IliUM
[lAIL
REG. NO
Arv!ilurJI
f If F :',1.. )
8VERGBE~N ~TATE DUILDE8~
PO BOX 397~.3
LAKEwnOD, HA 98499
L' UJ (, r~ (') 1 4'J Y L
~'15/17/\)!) J(; "7 ,=' 7
1\'),267 b9 CHEC~
Pr~NDING
DUDGETAHY
'~I 'ei..
~5 it,} YiLI TEHP1\ Wi" SE L14
__'u_ -----------.-~-- [i-,EANA
D L [i i' f{ ill 3 ) J 1 '3, F L N F r. If 5 E. 7:;, I Ice !l F P IlT;, 4-
1 ::i ~ i (I, j'!,' ! I T n 30(1, vi 1 DE r .H3, T R A F F 7 'j 7 ':>' . .:;
"' r"
I.) "
PLllHl:-'r-:IITI H'"
'.J / TN'::; P 1 4 I) \f' r:}~ [l
~ / r:.; f( U .' ,t J i .
DI::r s,.;. ::,TFr.CL] ')Ii
~w
, f^' \~1 V F Lfd'
I -I .... \. -j h..' _.J ~~. .
I /. .J
..:: 9/
~ P"
~ "-' ~ ~ "
dr~~ ~~t.' t~ '~
ii I
L~:' '-::'::=-J
I (I flll> .1,<1
Y(:1111 ,-VI' r1/{(,q,
~iil) '~lH.g10;l
/EI~:;~
/ )
;:-IXT"{ ''[:~-fI~N OOLLI\1U: i'~ (51 CE;N'J'--: ;'
DAI E !-lEe NO MM)ll~H rlf'::luJ
05/17/05 i0.:b7 G1
BUDGETARY ~
,. ~
.LO , \ ....,'........~,. ---
, -._~"---~
1 :11_1 i'lf!
, . . . T L N '1' H \ I !J S l\tm Hi, I /{ U tJ UP E [I
I 'f I 1'lVf i) I f it H'~
I-~VE;nq 88:i STrITE B1J1LLIr;~ ~
t' U f3 () X ] y 7 :5 :)
LAKEWUUO, WA 984 I~
BL[J-\r1'J-OL4'~ IL
SITE; lr.)0'~5 yr;LIl Tf;RRA r.r[y ::~;E
--- ---- -- .-.----- .------..- t..LI-AN1\ "-,~---------- ----.------- ~-____.__ _________. _u_._._" __u____n
E'LDFF:/!Tl ~,li t', f'LP;v~il{,j r;, iifCH~Ptl'Ll i , PLll'-Jf'R[[Tll\.~. oJ/U1~,t L~rj,l'I1CHLJ1'J()()
\'! / l1'P n ',C (.). \-/ / U E I' 4 ~), T h j\f E' 7 5 7 'J ~l, ~, / 0 E; P ~) I", ::; T FEe 4 I~ (/, '3 / E R U ~ 1} J 7
G.lP'f~~'l'X~~$~~"&'"'''''~1f.:<1&J~~'f'I1'~~~~~t<.11li't~it'\l'ft''''"~~'~~~~~~1Ji'lli~'!;'f~"C,.~"" .,n'''', """""""' I"
ita~~~f~~4'~~~~]':'w ~ "..,.e,.
I, V~~j ~-'rrY Of'
(/ ',' ~~~~'YELi\/l .
I. {\ f"( \ [.;",1 '9
1 , ! 1,'111' 'NIl 111:,,>(
I r-~i.-;.' r. ?'5.~~'-.-'1! l(ji I I! ~lB Pol) (l:~
~.~-'.-~-~,-.-..
,
I l I r I,! I II
I
I
I
I
FlECEiPT No =: 6 7 G 9
... ., '" · '1' 1:, t.)
TliU Ui,Aim
f [) T] l~ HUN u f'F~ 11
rrHEHT'{ C IrJHT
D('LLAH:J t:"
'J J CEJJ'ru
I if , [J.tL I) Hl( lIvl
DAlE
m,c NO
AMULJN I
rllTI'j()
EVERGREEN STATE BUILGERJ
r ,I B () X J 'n 5 3
LAK;:;\-lU()j). 1'1<'1 ~l~4_lq
8LO 0', ~:)l'1,-)"1
;e;ITe ISIS';: '"LLri TERPA Wl.:JE L::~
() S / J 7 ;' ~I 5
367G9
H",428
9J r'HSf'j;
PENDING
BUDc"CTARY
--------------~----ftIAHA --'--,-'----.. ------ .___n_
I ir, 'pr~-;'! J'l J'J r[t,!'-<fVS?~; 21, W:r'IIPRJiT7;\ 7r;. PLl1BPfm'l'lJ~ 'J/1N:JI"14'::;,I'1I[HU1'JI.)O
FJ/f'j'ld'-it \'/~r;1'4"'). Tfu1rf7',! S~)_ ::'/fJr:~'~;,). :;TFLI~4 5'.1, ::,/GIW.,lll
LOT 14
EVERGREEN STATE BUILDERS
YELM TERRA
15769 YELM TERRA AVENUE SOUTHEAST
YELM, WA
o
o
SEWER
LINE -YELM-TERRA-AVE~-SEi----
LINE - .~-~~-~---~BJ_~+_~
I I
I 000'
44.
o
o
N
WATER
AVM3^'!lO
20' BSBL
I III -I
o g: ~ II :~ : (:, 0
'!] g I ::211 (11 3~VClV~) I~ I ~ '!]
I-Tf-..ill zjoozz NV1d I ~
I II I
I JI G--=a=j.~11
o 25' BSBL
..q- - 8 9 44 0 7 1'- ~
""' I I ""'
SIOEWALK~ - -60,OQ' - - ~
CURB
STORM LINE - - - - --- --- --olIIIIIIIIIIII- ------ --- - ---- ---
1 05th AVE. SE
SEW E R LI N E =-=-=- - ~ ~:= -=-== -=- - -=-=- - ~ ~ ~ --== --- ----=-=
~~ SITE PLAN
~5pRmn ~'!Er""'h
_ '0 V_~LJ _
-:5 )~L-
@
NORTH
,
lQ 2005 CASCADE RESIDENTIAL DESIGN INC
SCALE \' = 30'
IHIS 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
o (\
ProjectAddress:47~? W~ ~.KL'A ~ ~ ~~#. ')jOo/ o!
SUbdiViSion:Ye(rv1_I--frrt'lL LotN- L~ Zoning; ~.flg It.) --f{JtH{1 I')
~ew Construction U Re-Modell Re-Roof I Addition U Home Occupation Sign
U Plumbing U Mechanical U Mobile I Manufactured Home Placement U Olher
Project DescriptionlS(:ope of Work: ~L1l fJ II? .F atv'l, 0 ee ~j dlhLI-, tZ. {
Project Value. ;23'7'. 76<:::::>
Building Area (sq. ft) 1st Floor / / 7 Z-- 21'od Floor /0$ Garage .rrt# 0 Deck
Basement Carport Patio ~/b
# Bedrooms.-1.. # Batt-l~OOms Z 'S- Heatin~OTHER or ELECTRIC (Circle One)
Are there any environrnentaUi sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER NAME:
ADDRESS S~:-~
CITY /...a.A__ _ STATE
ARCHITECTIENGINEE ~. -.s'
ADDRESS h fa ~). ~
CITY7Zl.LJJiiI STATE :t:<./l ZIP 9'(.#/z
LICENSE #
EMAIL
TELEPHONE
GENERAl.. CONTRACTOR \~ as 071J1Ltr TELEPHONE
ADDRESS EMAIL
CITY STATE FAX
CONTRACTOR'S LICENSE # e14 EXP OAT t1l CllY LICENSE #
PLUMBING CONTRi\t;rOR...I
ADDR~~~-17~
CITY fa . STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX Z<)-,~~-9?~
EXP DATE CllY LICENSE #
MECHANICALCONTHACT9R,~N~~.7 #e!Ar7N'7 TELEPHONE U-j S "'6"~?.J'.rc:>
ADDRESS5SZG /f''VY'' 5r .$rM 4, EMAIL
CITY"";;jf,!'U;/~ STATE~? lIP?.d'/7S-FAX 'ZS'J ,#"7S-#zf,s-
CONTRACTO 'S LICENSE # EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Commuhity Schools. if applicable
I hereby certify thaI the above Information 15 correct and that the construction on, and the occupancy and the use of the
above described property will be In accordance with the laws, rulel and regulaUons of the State of Washington and the
City of Yelm.
/~__ ~ -..5"-/I.? -0$
Applicant's Signatll~, Date
Owner I Contractor l~ 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 i!s!.uance, or if work is suspended or abandoned for a period of 180 days
(360) 45&.-3835
(360J 458-3144 FAX
www.ci...elm.wo.us
105 Yelm Avenue West
PO &x 479
Yelm,. WA 9859'/