BLD-05-0106
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elT'" Of "'ELM _ BUILOING oEP ARTMENT
RESIOENTIAL CERTIfICATE Of OcCUPANC'l
BUi\di09 Address
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owner Name
owner Address
plan Number
Bui\ding permit Number
s?ecia\ conditionS
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RemarKS
-----
Areas \nspected
None
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Date
BUi\di09 OHicia\
, . . 'Ih lno Inlernalional Residenlial Code (Chapler
1his slruclure IS 10 cm"pl.."Ce;Z' h' 10" Slale Buiiding Code council pUlSUa,,1
51-51 WAC) as adopted ~'19t 2"'1e ""da~~"~2 RCW effeclive MY 1, 20M
to c",a?ters I pl' '
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CITY OF YELM INSPECTION LOG
PROJECT
t..,.../- ~'1 '-I"
PERMIT NUMBER ~- D100>
ADDRESS t b~ Z> Le
WALL
CJ 6"
;i 8"
o other
lIe-
/' Dale 4- WALL REBAR ,,/ Date #
SET BACKS Date
Front 2-0
Rear ~'"
SIde Flankmg If)
SIde (p
FOOTING
Q 12"'
~ 16"
o other
o reqUIred vents
J
1) 5)~
FOOTI,\;G REBAR
C0n~~e~!~
CO\lBI~ED FR.\~lE/ EXTERIOR SHEAR W .\LL I\SPECTIO~
Hold downs J Shear Nadmg J1 Jv v/?;;;i?'
Frame =:J ~/ ~~/ Gas/Propane ::J a.Jv "7/f);
PlumbIng ::J ~< Mechanical CJ
Comments ChI- ~~ ~ ~}~<h{
, I 1
I'\Sl LA TIO~ ~ Gas
rp F oarn and Seal
Commenls~ 1J9$ ~
SHEET ROCK/SHEAR \V .\LL :\AIL
CJ Electric
=:! Vaporbarner
Q Other
:t PV-\
Comments
OTHER
Comments
F1~AL
/'
~ Sewer Final
)d'- Address
.2" Electncal 0 Cml Fmal
l2J' InsulatIon 0 SIte Dramage
Commenls C>~""'\ t1VqjlVl I~
o Landscape F mal
=' SJdewalJ...
o C of 0
FROM YELM SEWER DEPT
FAX NO. 360-458-E3166
Sep 14 2005 03 34PM Pi
11-
1,,1;
II
FAX TRANSMISSION
CITY OF YELM
P.O. BOX 479 - 931 NP ROAD NE
YELM, W A 98597
r' ,\ 360-458-8411
'<J ~\ FAX 360-458-8] 66
TO: 6--R.~r!-EA.J DATE: q~IY~o:)
FAX#:
FrOll1 "g AN [) Y
PAGES: I , including thIS
Cover sheet
SubJcct PINA-LS/ i't.Ln---. l~RJ\
,.. c. --c... c ere" 00
u-) ..)-..J
COMMENTS: ~ T- 5g.; 1 ~~rG:,
LoT G<7 )4J?;q~
I
t/) - 5~oO oU
/OLr/11 Ave <) f?
YUhI \t\c\LA WAY S,E
*LJ~ I TfY~(lA W/tY 5. G .
loLft11 Ave $
H If you do not receive all COplCS or any copy IS not legiblc. please call (360) 458-84 J 1
as soon 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-05-0106-YL
Issue Date. 04/15/2005
(Work must be started within 180 days)
Receipt No
36177
Applicant:. .
Name. Evergreen State Builders
Phone:
253.475.6622
Address. POBox 39753
City' Lakewood
State. WA Zip 98499
PropertyJl1formation:
Site Address. 15886 104th Ave SE
Assessor Parcel No. 85840005900
Subdivision: Yelm Terra
Lot: 59
Contractor inforiTlCltion:
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
PrQjec:Jll1f9rmation:
Project: Yelm Terra
Description of Work: Plan 2200 /2A Lot 59
Sq. Ft. per floor' (1 st) 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 1,30119 993.75 307 44 5.6000 54 9000 $1,000
Building Plan Review 549.75 000 000 o 0000 0.0000
Mechanical Permit 8475 000 0.00 o 0000 0.0000
Plumbing Permit 118.00 2000 98.00 7 0000 14 0000 Fixture
Sewer Inspection 14500 000 145.00 145 0000 1 0000 ERU
Water ERU 1,500 00 000 1,500.00 1,500 0000 1 0000 ERU
Water Meter (SFD) 300 00 300 00 0.00 o 0000 0.0000
Water Deposit 4000 4000 0.00 o 0000 0.0000
Traffic Facilities Charge 757.50 000 757 50 750 0000 1 0100 Peak PM Trip
Sewer Deposit 50.00 5000 0.00 o 0000 0.0000
State Building Fee 4.50 450 0.00 o 0000 0.0000
Sewer ERU 5,41700 000 5,41700 5,4170000 1 0000 ERU
TOTAL FEES $10,267.69
Apl?!i~~I1t's At!~ct~"it: .
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 S W~hington.
.
OFFICIAL USE ONLY
# Sets of Prints:
Signatu
Date
· os-
Firm
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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
Address. P O. Box 39753
Project Information:
Project: Yelm Terra
Description of Work: Plan 2200 /2A Lot 59
Site Address. 15886 104th Ave 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
160 001-386-00-00
Sewer ERU
802 412-343-50-01
PAID
APR 1 5 2005
CITY OF YELM
TOTAL FEES.
Permit Fees Schedule
Permit No BLD-05-0106-YL
Phone:
253.475.6622
City' Lakewood
State. WA Zip 98499
Assessor Parcel No. 85840005900
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 75 000 000 o 0000 o 0000
8475 000 000 o 0000 0.0000
118.00 2000 98.00 7 0000 14 0000 Fixture
145 00 000 145.00 145 0000 1 0000 ERU
1,500.00 000 1,500.00 1,500 0000 1 0000 ERU
300 00 300.00 000 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
5000 50.00 000 o 0000 o 0000
4.50 4.50 000 0.0000 o 0000
5 417 00 000 541700 54170000 1 0000 ERU
$10,267.69
o
RECE!PT No. 3 61 7 7
RECf-~ifkN THOUSAND TWO HUNDRED SIXTY SEVEN DOLLARS & 69 CENTS
o
RECEIVED FROM
EVERGREEN STATE BUILDERS
P O. BOX 39753
LAKEWOOD, WA 98499
253-475-6622
SITE 15886 104TH AVE SE
DATE REC NO
04/15/05 36177
AMOUNT
10,267.69 CHECK
FiEF NO
PENDING
MISCELLANEOUS RECEIPT
GRETCHEN
./
PBD PER 1301 19,PLN REV 549.75, MECH 84.75,PLHB 118, SEW INS 145, WATERU 1500
WAT MET 300, CONS DEP 90, TRAF 757.50, ST BLD 4 50,SEW ERU 5417
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Yelm School District
ATTN SUSAN CROY
PO BOX 476
YELM, ~JA 98597
360-458-1900
Sold to: 16755
EVERGREEN STATE BUILDERS LLC
56622
BUILDERS LLC EVERGREEN STATE
5516 75TH ST W #1
LAKEWOOD, WA 98499
# 5867 13 04/15/05
Reg #1 SalesPerson BONNIE
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJECTS
1 @ 3,422 00 3,422 00
Yelm Terra - Lots 41 & 46 ck#9517
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJECTS
1 @ 5,133 00 5,13300
Yelm Terra - Lots 56, 58 & 59 ck 9438
SubTotal
8,555 00
Total Due
Check
8,555 00
8,555 00
----------
----------
Thank you
PLEASE KEEP THIS RECEIPT'!'
03/31/2005 14 34
253284;'"-83
U
CASCADE RESIDE~L
PAGE 04
LOT 5'3
EVERdREEN STATE BUILDERS
I
YELM TERRA
16886 l04thAVENUE SOUTHEAST
YELM~ WA
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~JJE PLAN APPROVAL
API'llllYrn !..~ f'll(~[NTtO IllVr,t ANO ~~lf8~IT
W/ltwtb BY (CLIENT),
OAT[;
NbIES'
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. SITE PU\N
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NORT~
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~ 200"'> CASCADE RESII)ENTIAI_ DlSIGN. INC
i
THI~ D~^W1NG IS R^~~D ON CUENT .r~OVIOEO INFORt.lATION REPRESE~r.R TO ~~ AGGURATr.
AND R~uABl.E. ANY OISCREPAJ<jCI~S .<TWEEN THIS ORAWING A~O THe ACTUAL Sin: CONDITIONS
A~r. TJ.'~ 'Sou: RE'~PO""~I~ILrTY OF" THe: ~1.rE]\IT '
~
SCALE I' : 3~'
projectAddress:(d& ~A'.ve;;g. Pan:el1t 0
Subdivision: Ye I h1 -Ur r Pi.. Lot #. 09 Zoning; ..&U1. g it -ftllht, 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:~ f} I fJ -F attll 01 R.t. &t du.J I CL I
Project Value~ Z :! ~ ~6-V ,
\
Building Area (sq. 1\) 1st Floor //71:- 2nd Floor /0 Z~ Ga~ o/~O Deck~~
Basement Carport Patio / ~ 0
# Bedrooms...A. # Bathrooms~'o Heating:(~~)THERor ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
R~
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4pI( 0 v~/)
1 1(J(JS
BUILDING OWNER NAME.
ADDRESS
CITY
:6
f
ARCHITECTJENGINEE
ADDRESS ,b 2- ~
CITY7ZlClJrlla STATE tA-/J ZIP 9~~z
ICENSE #
EMAlL
TELEPHONE
GENERAL CONTRACTOR \~ as trUfLtr TELEPHONE
ADDRESS EMAlL
CITY STATE ZIP FAX
CONTRACTORS LICENSE # t:14 .. EXP DAT~CITY LICENSE #
TELEPHONE~7.5::~7 l?9tJ t:)
EMAlL
FAX Z <::a;- ...s::% - q~~ A,
EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
ZIP
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby certify 1haI1he above information is CcmlCt and that the construction on. and the oc:cupancy and the use of the
above described pIOpertywW be In accordanc:e with the laws, rules and regulations of the State of Washington and the
City of Yelm.
/~~ .... J:cr(!7 ~&tS-
Applicant's Signature ~ Date
Owner I Contractor~ner's Agen 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 Box 479
Yelm, WA 98597
(360) 458-383S
(360) 458-3144 FAX
www.ci.)1I!.m.wo.uil