BLD-05-0103
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crf'( Of '(ELWI- 6U\LO\~G OEP ~R1W1E~1
RES\OE~1\~L CER1\f\C~1E Of OCCUp~~c'(
Building J\ddress
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owner Name
owner p.,ddress
plan Number
Building permit Number
RemarKS.
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p..,\1 Code ReQuired
J\reas \nspected
special conditions
None
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Building Oi~icial
. . 10te!Oatiooal Resideotial code (Chaple!
ThiS st!UClure is io COOlpl13oce :;t:~~: toO state Buildi09 Code couocil pUlSUaol
5~-5~ \NJ\C) as adopted b'Jgt 2n7ea d 70 ~z RON ellecti.e Jul~ 1, Z004
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CITY OF YELM INSPECTION LOG
PROJECT
W~~
PERMIT NUMBER
() r- /' t::> / t> ?-:>
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ADDRESS
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Date
2-Z-
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7
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FOOTING WALL
Q 12" CJ 6"
9" 16" ;:Y8"
o other 0 other
o reqUired yents K W
WALL REBAR ~te sIt"
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SET BACKS
F rent
Rear
SIde Flankmg
SIde
FOOTI~G REBAR v Date ,)} 3
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C 0!"'!!!1e!:!~
u-' ~b~
CO'lffi;\[i#RA!\lEI EXTERIOR SHEAR WALL I\SPECTIO,",
Hold downs ::J Shear NadIng 0 I
Frame J ~'~ Gas'Propane~ ] -':!~ '1/i1g(
PlumbIng ] ,Jr- 17!f!/~ Mechamcal ~ I
Commeolsow-c....- '~11JSJo /
I'\Sl LA TIO~ ;Y'Gas
y Foam and Seal
Commeots~ 1J<Yi kl ~ Y
SHEET ROCK/SHEAR ~\'ALL :\AIL
CommeolS~ ~13
OTHER
CJ Electric
~por bamer
~ Other
~ p\,-\
Comments
Fl"'lAL
~" Sewer Final
I Address
Comments
,E Electrical
]S InsulatIon
Jvql~
o Landscape FInal
o SIdewalk.
o coro
CJ Clyll Final
o SIte DraInage
FROM YELM SEWER DEPT
FAX NO. 360-458-8166
Sep 19 2005 11 42AM P1
FAX TRANSMISSION
CITY OF YELM
P.O. BOX 479 - 931 NP ROAD NE
~ YELM, W A 98597
\'"' l\ ~. 360-458-8411
\J ~'t---" FAX 360-458-8166
TO. Irf'.~C)-..J DATE 'f'-1 q-O{
FAX#:
PAGES: I , including this
Cover sheet
From: (({rvJn~
Subject: f- It\.! A L/ '-fCLY'h Ta:..41
C-C;)~ I ')cl'<r;. (j L-? C. U r) Tt: (2JLft w A '-,J <. (' ,
COMMENTS: L 01 ) () -n:: .) .
/O'111L I} ve, 5 E
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** If you do not recclve all copIes or any copy IS not legIble, pletl3e call (360) 458-8411
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-05-01 03- YL
Issue Date. 04/15/2005
(Work must be started within 180 days)
Receipt No
36179
Applicant:_
Name. Evergreen State Builders
Phone.
253-475-6622
Address. P.O Box 39753
City' Lakewood
State: WA Zip 98499
Property Inforlllation:
Site Address. 15880 104th Ave SE
Assessor Parcel No. 85840005800
Subdivision. Yelm Terra
Lot: 58
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
Proj~cUIlJQrmation:
Project: Yelm Terra
Description of Work: Plan 1819/2, Lot 58
Sq. Ft. per floor (1 st) 1363
(2nd) 456
(3rd) 434
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 519.67 000 000 o 0000 0.0000
Mechanical Permit 8475 000 000 o 0000 0.0000
Plumbing Permit 132.00 2000 112.00 7 0000 160000 Fixture
Sewer Inspection 145.00 000 14500 145.0000 1 0000 ERU
Water ERU 1,50000 000 1,50000 1,5000000 1 0000 ERU
Water Meter (SFD) 300 00 300 00 000 o 0000 o 0000
Water Deposit 4000 4000 000 o 0000 o 0000
Traffic Facilities Charge 757 50 000 757 50 750 0000 1 0100 Peak PM Trip
Sewer Deposit 5000 5000 000 o 0000 o 0000
State Building Fee 4.50 4.50 000 o 0000 o 0000
Sewer ERU 5,41700 000 5,41700 5,417 0000 1 0000 ERU
TOTAL FEES. $10,181.05
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
registe . th f Washington.
.
OFFICIAL USE ONLY
# Sets of Prints.
Date
By'
Firm
Applicant:
o
o
Permit Fees Schedule
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Name: Evergreen State Builders
Address. P.O Box 39753
Project Information"
Project: Yelm Terra
Description of Work: Plan 1819/2, Lot 58
Site Address. 15880 104th Ave SE
Fees.
Item Acct Code
Building Permit 100-500k
Building Plan Review
Mechanical Permit
Plumbing Permit
Sewer Inspection
Water ERU
Water Meter (SFD)
Water Deposit
Traffic Facilities Charge
Sewer Deposit
State Building Fee
Sewer ERU
PAID
APR 1 5 2005
CITY OF YELM
032001-322-10-00
100001-345-83-00
032001-322-10-00
032001-322-10-00
805 412-343-80-00
712401-343-80-01
712401-343-80-01
740402-389-00-00
420 120-344-85-00
742402-389-01-00
160001-386-00-00
802 412-343-50-01
TOTAL FEES.
Permit No BLD-05-0103-YL
City' Lakewood
Phone. 253-475-6622
State: WA Zip 98499
Assessor Parcel No 85840005800
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
519.67 000 0.00 0.0000 o 0000
8475 0.00 000 o 0000 o 0000
132.00 20.00 112.00 7 0000 16.0000 Fixture
14500 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 000 o 0000 o 0000
757 50 000 757.50 750 0000 1 0100 Peak PM Trip
5000 5000 0.00 o 0000 0.0000
450 450 000 o 0000 o 0000
5,41700 0.00 5,41700 5,4170000 1 0000 ERU
$10,181.05
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Yelm School District
ATTN SUSAN CROY
PO BOX 476
YELM, WA 98597
360-458-1900
Sold to. 16755
EVERGREEN STATE BUILDERS LLC
56622
BUILDERS LLC EVERGREEN STATE
5516 75TH 8T W #1
LAKEWOOD, WA 98499
# 5867 13 04/15/05
Reg #1 SalesPerson BONNIE
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJECTS
1 @ 3,422 00 3,422 00
Yelm Terra - Lots 41 & 46 ck#9517
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJECTS
1 @ 5,133.00 5,13300
Yelm Terra - Lots 56, 58 & 59 ck 9438
SubTotal
8,555 00
Total Due
Check
8,555 00
8,555 00
----------
----------
Thank you.
PLEASE KEEP THIS RECEIPT I I I
o
04/05/2005 15 05
25328{1,""'83
U
CASCADE RESIDE~~L
PAGE 02
LOT 58
EVERGREEN STATE BUILDERS
YELM TERRA
15880 104th AVENUE SOtrrHEAST
YELM, WA
SITE PLAN APPROVAL
AI'1'IIOVr,D A! P.[~[~n:D ~~VIS~ AND ~~sue.~
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BeALE " : 312>'
0-2005 CASCADE RESIDENTIAL DESIGN, INC
THIS DR^WI~G IS BASEO ON curNT-PROVlOF,D INrO~MAtION R"PRESENTED TO ll~ ACCV.~IT
^ND ~tLI^aLr.. ANY b'SCREP^NCJr.~ BETWEEN THIS OnAWII'1G ANO THE tlCTV.lL SitE CONDITIQHS
ARE THE !Ol.~ otSPONSI9'L1TY or THE CLIENT.
o 0
Project Addrass:/5$St!J /~.y ~~~ ~ Parcel #'__
Subdivision: yef"w{ 1~e({A... loll' ~K Zoning; ,~<1..1e --f{#11I.1J
'~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 ofWork:\~~ It: -fUk!1/1g f!e :s./dfhS../.,tZ-1
Project Value: 2 Z ~ 7S-tJ
Building Area (sq ft) 181 Floor /'16" 2nd Floor, 1'&~_ Garage ~ ~.yO Deck
Basement Carport Patio__ Z /6
# Bedrooms r -1:1
# Bathrooms "Z -0' Healing. GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
completed environmental checklist must accompany permit application
If yes, a
BUILDING OWNER NAME.
GENERAl. CONTRACTOR \'UrtIlI1# a.s (Yfwur _TELEPHONE
ADDRESS_ EMAIL
CITY STAlE FAX
CONTRACTOR'S LICENSE # el/ ExP OAT 7~ CITY LICENSE #
PLUMBING CONT~J:o"-A#::' ~)'wd;'-. TELEPHONE 5;.'.-
ADDR~SJ8'/g -~r. ^~ _._EMAIL ._
cnv la<<iYf7bt STATE liP 98'Y!t:(- FAX2 (~S:~-q~<<7
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR ~b.t.lA-I eI Io/ry
ADDRESS ~6'Zc' /$.y~,v-:.e fA.)
CITY, 5T A IE ZiP
CONTRACTOR'S LICENSE #
TELEPHONE e6"J.. ~75""JJ'S"C)
[MAil
.FAX z..s:J - S 7..5 - J~O
EXP DA TE.....___CITY LICENSE #
Copy of mitigation agreement with Yelrn Community Schools, if applicable
I hereby certify that the above Information ill corred and tha1 the cOl'!structlon on, and the occupancy and the use of the
above descrfbed property will bIlln accordance with the laws, mlul and regulations of the State of Washington and the
Cfty of Yelm.
/ ~ t?-~ '~-6-as;-
Applicant's Signatu~-:-::~~---.... -^ Date
Owner / contractor~!!J1l Contractor's Agent (Please circ;:le 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 felm AVf!nul! WI!8t
PO Box 479
Ytllm. WA 9SS9'!
(360) 45lJ.38JJ6
(360) 458-3144 FAX
www.ci.~l!lm.wa. WI