BLD-05-0105
~@ill~~~
Cli'{ Of '(ELtJI _ BUILOIl'lG OEP ~RitJIEl'li
RESIOEl'lil~L CERilfIC~ iE Of ocCUP ~l'lC'{
Bu\\ding Address
owner Name
owner ",ddress
~
~
~~
~W~53
~
~
plan Number
Bu\\ding permit Number
Remar\<.s'.
---
A\\ Code Reauired
Areas \nspected
special conditions
None
~
oate.
Bui\ding Onic\at
. . I le(oaliooa' \1.esideolia' Code lCnaplel
1niS strUClUle is io c()lOp\\aoce ~':~: I~O Slale lluildi09 Code couocil pUlSuaol
5,-5' WAC) as adopted b,,/t 2"'7e d 70 i2 RCW enecti\le jUW '12004
to c",apters '9. an .
G. carlson
~~rd\~\Wil
c
c
c
CITY OF YELM INSPECTION LOG
PROJECT
Lo r- Y-L '"'I ..,-
PER.~1IT NUMBER
/1\ - -
v~ -- Dl c5>'Q
I t ~ 'I <JFIL---
ADDRESS
J .; 7 It t> l 0 ~ l:ll .4w SG
SET BACKS Date
Front
Rear
Slde'Flankmg
Side
FOOTING
CJ I 2"
.erl6 "
o other
o reqUIred \ ents
'7-D
~~
10 ~
/()
WALL
CJ 6"
....08"
o ot~_
<<' 1~
Date
C0~~~e!:!~
CO'lBI:\ED FRA!\lEI EXTERIOR SHEAR WALL I\SPECTIO~
Hold downs :J Shear Nailing 0
Frame ~'_~ Gas'Propane~ d ,,/1 ovl. fSl1
Plumbmg ;ZS (Jt- 1(J Mechamcal ~
0,J);
~ Other
" P\' ~
dt--.~ pI;
OTHER
Comments
;I. Electrical 0 CI\ d Final 0 Landscape F mal I C (If 0
~ Insulation 0 SIte Dramage [J Slde\\alk.
A 11/~/;:///
FOOTI~G REBAR
Date
W .\LL REBAR
Comments ftS~ / a1
t
I\Sl LA TlO~ ~ Gas
I} Foam and Seal
Comments ~/ 611,5"'
CJ Electnc
~ 'Vapor barner
SHEET ROCK/SHEAR \VALL ~AIL
Comments
Z~AL
Se\\ er Final
Y Address
Comments
FROM YELM SEWER DEPT
FAX NO. 360-458-8166
Oct. 11 2005 11 38AM Pi
FAX TRANSMISSION
CITY OF YELM
P.O. BOX 479 - 931 NP ROAD NE
0. YELM, W A 98597
r- "tw'"'\. 360-458-8411
'0 \~' FAX 360-458-8166
TO: ~Hf;V DATE: 10' /I-OS
FAX#.
PAGES: } , includmg thiS
Cover sheet
FrOln: Rf\;JD ~}
Subject. Ho US~ \-: uJ AL
[(jl-yih AI! f 5 S
COMMENTS: Lo'T L II) } ~-/- '.-...,<1.
.J ('J () :1'::') y'}-''l \ e' ~ I-
-.-' ,I ll--f\- wAY ~,t:..
Ot:J_,/jYlb'OO
H If you do not receive all copies or any copy is nOlleglole, please call (360) 458-R411
us soon as possible.
o
o
~..~....~~....".'.
~
'~
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0105-YL
Issue Date 04/15/2005
(Work must be started within 180 days)
Receipt No
36182
Applicant:
Name: Evergreen State Builders
Phone,
253-475-6622
Address. POBox 39753
City' Lakewood
State. WA Zip 98499
Property Information.
Site Address, 15768 104th Ave SE
Assessor Parcel No, 85840004100
Subdivision, Yelm Terra
Lot: 41
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 1819/2, Lot 41
Sq, Ft. per floor' (1st) 1363
(2nd) 456
(3rd) 0
Garage 440
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 1,230 63 993.75 236 88 5,6000 42,3000 $1,000
Building Plan Review 51967 000 000 o 0000 o 0000
Mechanical Permit 8475 000 000 o 0000 o 0000
Plumbing Permit 132.00 2000 112,00 7 0000 16.0000 Fixture
Sewer Inspection 14500 000 145,00 145.0000 1 0000 ERU
Water ERU 1,500 00 0,00 1,500,00 1,5000000 1 0000 ERU
Water Meter (SFD) 300 00 300,00 0,00 o 0000 o 0000
Water Deposit 4000 40,00 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 5000 000 o 0000 o 0000
State Building Fee 4,50 4,50 000 o 0000 o 0000
Sewer ERU 5,41700 0,00 5,41700 5,4170000 1 0000 ERU
TOTAL FEES $10,181.05
Appl iC,lint'13J\fflidavit:
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 oj Washington
'"
OFFICIAL USE ONLY
# Sets of Prints,
Final Inspection:
Date
· os-
Date:
Firm
By'
o
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 1819/2, Lot 41
Site Address, 15768 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 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-05-0105-YL
Phone:
253-475-6622
City' Lakewood
State. WA Zip 98499
Assessor Parcel No, 85840004100
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
-------------
1,230 63 993.75 236,88 5 6000 42.3000 $1,000
51967 000 0,00 o 0000 o 0000
8475 000 0,00 o 0000 o 0000
132,00 20,00 112,00 7 0000 16 0000 Fixture
14500 0,00 145,00 145,0000 1 0000 ERU
1,500,00 0,00 1 500 00 1,500,0000 1 0000 ERU
300 00 300,00 000 o 0000 o 0000
4000 40,00 000 o 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
4,50 450 000 o 0000 o 0000
5,417 00 000 541700 5,4170000 1 0000 ERU
$10,181.05
~,~ PAID
APR 1 5 2005
C1TY OF YELM
o
RECEIPT NO 36182
~IG"TY ON~ DOLLARS & 05 C~NTS
01\11::
04/15/05
REC, NO
36182
I\MO\JN1
10,181.05 Cllr.C\<.
REI' NO
pr.NDl}lG
RECEIVED FROM
~V~RGR~~N STAT~ BUILD~RS
p,Q. BOZ 39153 '
L~\<.E~OOD. ~h 98499
253_415-6622
SIT~ 15168 10~T" AV~ S~
o
BLD pr.R
~1\T H'ET
UISC~LLAN~OUS R~C~IPT
GRETCHE}l
15 PLUll132 SE~INS 1~5.~AT~RU
1230.63.PLNR~V 519.61. U~C" 8~cT BLD ~.50'S~~ ~RU 5~11 00
300. CONS D~P90. TRAY 151 50. "
1500
o
Yelm School District
ATTN SUSAN CROY
PO BOX 476
YELM, vJA 98597
360-458-1900
Sold to' 16755
EVERGREEN STATE BUILDERS LLC
56622
BUILDERS LLC EVERGREEN STATE
5516 75TH ST W #1
LAKEWOOD, WA 98499
# 5867 13 04/15/05
Reg #1 SalesPerson BONNIE
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJECTS
1 @ 3,422 00 3,422 00
Yelm Terra - Lots 41 & 46 ck#9517
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJECTS
1 @ 5,133.00 5,133 00
Yelm Terra - Lots 56, 58 & 59 ck 9438
SubTotal
8,555 00
Total Due
Check
8,555 00
8,555 00
----------
----------
Thank you
PLEASE KEEP THIS RECEIPT I I I
o
04/05/2005 16 06
CASCADE RESIDE~L
253284/,:>.",g3
U
PAGE 01
LOT 41
EVERGREEN STATE BUILDERS
YELM TERRA
16768 104thAVENUE SOUTHEAST
YELM, WA
SITE PLAN APPROVAL
^PPROVED AS 'RESElITED RrllSE AND RESUBMIT
REVIEWED aT (CLIENT)!
DM!;
NOTtS,
r1--_6_a"~--1l
~ I I ~
,.., 8 0 44 0 -,. 0 [ -
25' BS8L
1--------
~~
-~j
PLAN 1 81 9/2 I ~ · ;1;
(GARAGE LT.) ~: i ~ ~
11-- ~ ! I
20' GSBL' +-+
1S"SS8L 0
6000' . I
IJ) I I
Ll1 I I
STORM L1NE-N--- .------ ,------ .__.J__I____
:1.__. 1 04th AVE.SE, :
WATER LINE: ~~ -_~~~_~_-d--.-~
o
~
"it
I
- I II
o I
~1---l11
ml~~1
I~I
: : r
J
~ SITE PLAN
--'-Vf~---~
<.. (/
.._q,- ----4 '.
5 2005 CASCADE RESIDENiIAI_ DESIGN. INC
T~ls DRAWINC IS gA$Eb DN CI.I;.NT-PROVIOtD INfcR",^TION REPRESENTED TO eE Ac~\mA1'E
AND RElIABLE, ANY OISCRr.PANCIES 9ETWEEN THIS ORAWINC AND tHE ACTUAL SITE CONOlTlONr.
ARE THE SOI.E RESPONSIBILITY or t~E CLIENT.
rJ
.... f"\
'" ,)t
o~ ~
""p. & I'^
~ I
~ ~
oJ ~
..
" '"
~ c:
III 8 ~ ~
a;
D u.. lJ. U.
~ f'J
~ .:r
I'-- 40
-.D
,
~ re
z I
~ 0
u. ...0
~ ... r
~z CD ...
~
:g ~ .t: ~
0.. a.
@
NORT~
SCALE I' ~ 30'
projectAddress:576HtI?~A~ Parcel#' 0
Subdivision: Ye (WI. -rei (A- lol # -& loning;9At g.fe 41;f>/,j 'j
'~ew ConstNdion U Re-Modell Re--Roof I Additiun u Home Occupation Sign
U Plumbing u Mechanical U Mobile I Manul'actured Horne Placement U O/her
Project Description/Scope of Work: \~ tj (t: -tUA1'1/ (fJ f!e :&t d/hC.l, tZ.1
Project Value: 2- ~ 'Y, 7ft:>
Building Area (sq ft) 151 Floor /1 ,g 2'lO Floor '7<~ I:, Garage ~"7"o Deck ,e/.1tj
Basement Carport__Patio ?;I b
# Bedrooms3::f-1 # Bathrooms 2 .~ Heating, GAS/OTHER or ELECTRIC (Circle One)
Are there any environmenta!ly sensitive areas located on the parcel?
completed environmental checklist must accompany permit application
If yes, a
BUILDING OWNER NAME. c--'" '~~ g~L~,~~ ~
~~~Y.4(/.~STATE. ?l' ZIP~?#J i~~~HON~LJS~3)~~~~~ I
ARCHITECTIENGINEER m:~tI?(d.{l z?~~AICE.NSE #~
ADDRESS ,b L ~ ~'1c~ EMAIL - -
CITY-721.Cirfla :STATE ?l./;r ZIP , TElEPHONE-
GENERAl CONTRACTOR, \'V2./I/lfJ,# a.s ~~ TELEPHONE
ADORESS_ EMAll
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # ell" ExP OAT '~CITY LICENSE #
TELEPHONE 5:"
EMAll
FAX..2'?:.~S~-q~
F..xP DATE CfTY LICENSE #
/
~.
/
/
ZIP
MECHANICAL CONTRACTOR~~o ~~ TELEPHONE UJ- ,g7S""J'~.fo
ADDRESS :r~~ ~,,7"I SrL .4 M#/ EMAIL "
CITY~&e:~_STATEW'?, ZIP94"J'~'- fAX Z5'3~S76 9dZr-s-. ~
CONTAACTOR'S LICENSE # EXP OA TE"",,___CITY LICENSE # \.
Copy of mitigation agreement with Yelm Community SChOOlS, if applicable
I hereby certHy thaI the above Information ill cOmlCl and tha1 thll COh5tructlun on, ~uld lhe ~cupancy Bnd the USA of tlu!
above described property will be In accordance with the law8, rulss and rwtgu/atlons of the Stal. of Wsshlllflllln and Ihe
City of Yelm.
~~--:::-~-= . ~,_, 7'-6 -~~
Applicant's Signature __.-----... . Date
Owner I Contr8ctor~ Contractor's Agent (Please circle one.)
All permits are non-transferable and will expire If work authoriz:ed 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 9859'1
(360) 448-3835
(3fiO) 158-3144 FAX
www.ci..l!lm.wa.WI