BLD-05-0102
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crt'/' 01' '/'ELNI- BUILOING OEP />.R1N1ENl
RESIOEN11/>.L CER111'IC/>.lE 01' OCCUP />.NC'/'
Bui\din9 A-ddress
owner Name
Owner p..ddress
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~W~753
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p\an Number
BUi\din9 permit Number
RemarKs
------
p..," Code ReQuired
A.reas \ns~ected
specia\ conditions
None
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Date
BUi\din90tficia\
. . 10leloa\iOOal Resideotial Code (Chap\el
.hiS s\IUeMe is io eOI1\pllaoee ~l\h ~ne \ 0 Slate Buildi09 Code couoeil pu(Suao\
5~-5~ Wp..C) as ado~ted b,/ th7e das7010i20RC'J'J e<<eclive JulY j. 20M
to Chapters ~9.2 an '
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CITY OF YELM INSPECTION LOG
PROJECT
U ';)-t"
PERMIT NUMBER
6>}-- %L
/.f~ (,~ /oll t.K 4-H SE-
ADDRESS
SET BACKS Date
Front
Rear
SIde Flanlmg
SIde
FOOTING
~ 12"
.E:f 16"
o other
o reqUired, ents
WALL
~ 6"
z.o
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7
.5
FOOTI'\;G REBAR /' Date
WALL REBAR
)21' 8"
o other
1'1
(
~ate#
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C0r!!~e!:!~
CO:\lBI;\"[D FRAl\lEI EXTERIOR SHEAR WALL I\SPECTIO~
Hold downs:Jj . " Shear Nailing C
Frame ,; ~ ~ Gas'Propane l~f!;JI./
Plumbing 2f tr-t-' tU:fI~ fJ'} I" MechanIcal CJ /
I
Comments ~\.h..~) ~NJ~- \t L~'tf I ~ '6)~ .c;~y')J w... iJlItV~
I. {
I\Sl LA TlO~
Comments
l. Gas
.1 Foam and Seal
Jv ~I~\
!J Other
'I PV -\
~ ElectrIC
!J Vaporbarner
SHEET ROCK/SHEAR \VALL :\AIL
Comments
OTHER
Comments
FI~AL
i Sewer Final
, Address
't Electrical 0 Cml Final 0 Landscape FrJd. ....0 C oro
YlnsulatlOn 0 Slle Drainage / Slde\\alk.AV4'f/"
~ - l'~p('-
Comments
FROM YELM SEWER DEPT
FAX NO. 360-458-EJ166
Oct. 14 2005 03 38PM P1
FAX TRANSMISSION
CITY OF YEIJM
P,O. BOX 479 - 931 NP ROAD NE
YELM, W A 98597
360-458-8411
FAX 360-458-8166
TO:
DATE. /0"'14- 0)"
FAX#:
PAGES: I, includmg this
Cover sheet
From: t<"A-,AJ~ Y
Subject: '-to u.. SE IF-I N PrL
Av~
COMMENTS: L.oT J-~/ I~~fo~' 1 oLI-r~ ~ S. ~ .
t/5-- ~ 5~ 0 .00
"'* If you do not receive all coples or any copy is not legible, please (:all (360) 458-8411
as soon as pos~iblc
o
o
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0102-YL
Issue Date, 04/15/2005
(Work must be started within 180 days)
Receipt No
36180
Applicallt:
Name: Evergreen State Builders
Phone,
253-475-6622
Address. P.O Box 39753
City' Lakewood
State: WA Zip 98499
Property Information:
Site Address, 15868 104th Ave SE
Assessor Parcel No 85840005600
Subdivision: Yelm Terra
Lot: 56
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, 10/02106275
Business License, 1042.0
Pr()ject Information:
Project: Yelm Terra
Description of Work: Plan 2502 S/2, Lot 56
Sq, Ft. per floor' (1st) 1034
(2nd) 1467
(3rd) 461
Garage 0
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 1,408,90 993,75 415,15 5.6000 741340 $1,000
Building Plan Review 595.26 0.00 000 0,0000 o 0000
Mechanical Permit 78.75 000 0,00 0,0000 o 0000
Plumbing Permit 132,00 2000 112.00 7 0000 160000 Fixture
Sewer Inspection 145.00 000 145,00 145 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 0,0000
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 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. $10,428.91
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 ap y' g as a contractor, I futher certify that I am currently
registered ' W<fShingt~n.
OFFICIAL USE ONLY
# Sets of Prints:
Date
· os-
By
Firm
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dSiJ' if71~- (g/C/7
Permit Fees Schedule
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 2502 5/2, Lot 56
Site Address: 15868 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 No BLD-05-0102-YL
Phone:
253-475-6622
City. Lakewood
State. WA Zip 98499
Assessor Parcel No, 85840005600
Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
-------------
1,408,90 993 75 41515 5,6000 741340 $1 000
595,26 000 0.00 o 0000 o 0000
78.75 0.00 000 o 0000 o 0000
132,00 2000 112.00 7 0000 16,0000 Fixture
14500 000 145,00 145.0000 1 0000 ERU
1,500,00 0,00 1,50000 1,5000000 1 0000 ERU
300 00 300 00 000 o 0000 o 0000
4000 4000 0,00 o 0000 o 0000
757 50 0,00 757 50 750 0000 1 0100 Peak PM Trip
5000 50.00 000 o 0000 o 0000
450 450 000 0,0000 0.0000
5,41700 000 5 417 00 5,417 0000 1 0000 ERU
$10,428.91
PAID
APR 1 5 2005
CITY OF YELM
o
RECEIP'OIO 3 51. ~ G
REC~W~N T~OUSAND yoUR ~UNDRED T~ENTY EIG~T DOLLARS & 91 CENTS
DI':TI: REC, NO
04/15/05 361B0
AMOUN\'
10.42B,91 Crn1C~
REI" NO
PENDING
RECE\\JEO FROM
EVERGREEN STATE BUILDERS
p,O, BO! 39153
LA~EWOOD. WA 9B499
253_415-6121
SITE 15868 104TR AVE SE
MISCELLANEOUS RECEIPT
GRETCHEN
r.~'Q1"Sl~-'n\lrojf50~wr;-T}Ilff-300/
B~D 4,50. SE~ ERU 5411 00
o
CONS
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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?'-Q3
U
CASCADE RESIDE~c==JL
PAGE 02
I LOT 50
EVERGREEN STATE BUILDERS
YELM TERRA
~ 15868 l04thAVENUE SOUTHEAST
YELM~ WA
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SITE PLAN APPROVAL
APl'1lO'Im .s PREsmED
.r,YJF.Wf:D R~ (CLIENT),
REVISE AND USUSMI!
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NDT[S;--'-
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~mbl~~ SITE PL4N
---------.--..----..-.......... -.. '--"',-"-'-"'-~-
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o 2005 CASCADE RESIDENTI\\L DI- SIGN, INC
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THIS ORAWING lS BASED ON ClIENT-PlloVIDED INFORMATION R~~RESENT(D TO B[ ACCuRATE
AND IlrLIAB~r., ANV OISCREPANCIES 9ETw~EN THI~ DRAWING AND THE ACTUAL SITE CONOiTIONS
dE TH( SOLE RESPDNSIRII,ITY Or THE CLIENT
---f/jAC------
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SCALE I' " 3~r
CITY OF YELM
RE~-~"'i.NTIAL BUILDING PERMIT APPLlCATU80RM
Project Address /6'gC~"7""7~vG ~ Parcel #'
Subdivision: Ye (M. --ref r dL Lot #. l ~t; Zoning; .&/.A1.. 0 l.e -+{.{Ih1/ 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: ~ fJ I ~ -raM I' 0 R-t. &tduJ-1 CL-f
Project value!' -< ,'19 ~5""o
Building Area (sq. ft) 1st Floor /~.1~ 2nd Floor /7167 Garage 9'tb/ Deck /6 t!J
Basement Carport Patio
# Bedrooms~ # Bathrooms-Z,.:;- Heating@oTHER or ELECTRIC (Circle One)
~~c
41'tf O/,I V It ()
ItltlJ
Are there any environmentally sensitive areas located on the parcel?
completed environmental checklist must accompany permit application
If yes, a
BUILDING OWNER NAME. E
ADDRESS
CITY
ARCHITECTIENGINEER - -$- ~
ADDRESS)Jl ~ . -
CITY72lCiJrfla
GENERALCONTRACTOR \~as, ~ TELEPHONE
ADDRESS EMAIL
CITY STATE FAX
CONTRACTOR'S LICENSE # el4 EXP DA T~ ~ CITY LICENSE #
PLUMBING CONTRACl~~7'
ADDRES~g -cnil ~ p-
CITY J2l ~ IlL. STATE U/I
CONTRACTOR'S LICENSE #
TELEPHONE~J537 ff'9'tJO
EMAIL
ZIP',18'V~'\ FAX Z~~s:%-q?~
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 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.
/~~ :?-jC?~~t5-
ApPlicant's Signatu~f Date
Owner I Contractor~ 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 WeBt
PO Box 479
Yelm, WA 98597
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wa.us