BLD-05-0083
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CIT'{ Of '{ELIIII- aUILOING OEPjl.RTIIIIENT
RESIOENTljl.L CERTlflCjI. TE Of OCCUP j1.NC'{
Building permit Number
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Building Address
owner Name
owner Address
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plan Number
s~edal conditions
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seotember 27 2005
Remar\<s
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Areas Ins~ected
None
Date
Building Omcial'
. . . . th I lefoat'Ooal Resideolial Code (CMptef
,hiS SlfuctUfe IS 10 compl,aoce ;'llh h e to state Buildi09 Code couocil pUlSuaot
5~-5~ WAC) as ado~ted ~'19 t2"7ea"'da~;;i20RCW effectIVe July~, 2004
to c"a~ters \. \' '
G. carlson
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CITY OF YELM INSPECTION LOG
PROJECT
Uu{
'7/
WALL
~ 6"
o 8"
o other
l;h-
Date
C0!"!:!T!e!'!~
CO'lBI~ED FRA:\lEI EXTERIOR SHEAR WALL I~SPECTIO~
Hold downs ::J Shear N31hng .1.1. ef4., 512.. t,
Frame :J.1k4:: tl1~ Gas'Propane ;!,~ rfJ/t (j /)t
Plumbmg ) 'iJ~~~( Mechamcal 0 /
Comments W 5/" ~tJ(/~ J--1k l~
n Other
~ PV-\
Comments
OTHER
Comments
FI~AL
It Se\\ er Final i ElectrIcal 0
it Address r Insula,,/
commeots~J~ (),
CJ\ 11 Final
Site Dramage
o Landscape Jlm~1 0 C of 0
~ Sldewal~ 4J/'
PERMIT NUMBER
Of(;-bD~3
/ () II vt- I~M 0~
ADDRESS
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,
SET SAChS Date
F rant
Rear
SldeFlankmg
Side
FOOTING
~ 12"
o 16"
o other
o reqUlred \"ents
70
'-17
13
0-
FOOTI~G REBAR
Date
WALL REBAR
I'\Sl L -\ TIO~
;] Gas
o Foam and Seal
~ Electric
~ Vaporbarner
SHEET ROCK/SHEAR '''ALL ~AIL
Comments
FROM YELM SEWER DEPT
FAX NO. 350-458-8166
Sep 27 2005 11 52AM Pi
FAX TRANSMISSION
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CITY OF YELM
P.O. BOX 479 - 931 NP ROAD NE
YELM, W ^ 98597
360-458-&411
FAX 360-458-8166
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PAGES: I , including this
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COMMENTS l-oT 4q/l5<tdk JDt.l11!Au~, S.~. 65-'5L/t([JO'1'
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From: RfwoY
Subject: l-\c,tA')E" r-;/J~~ 'fELm '1CQ.17A
'H If you do not receive all copies or any copy 1$ not leglble~ please call (160) 458-R4 t 1
as soon ns posslblc.
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0083- YL
Issue Date 03/16/2005
(Work must be started within 180 days)
Receipt No
35906
ApPl.icant:
Name. Evergreen State Builders
Phone:
253-475-6622
Address. P.O Box 39753
City' Lakewood
State W A Zip 98499
Property Information:
Site Address. 15819 104th Ave SE
Assessor Parcel No 85840006500
Subdivision: Yelm Terra
Lot: 65
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<<;lct Information
Project: Yelm Terra
Description of Work: Plan 2150 S/2 Lot 65
Sq. Ft. per floor (1st) 888 (2nd) 1262 (3rd) 0 Garage 432 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 1,276 77 993.75 283 02 5.6000 50.5400 $1,000
Building Plan Review 539 44 000 000 o 0000 0.0000
Mechanical Permit 78.75 000 0.00 o 0000 0.0000
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 1,50000 000 1,500 00 1 500 0000 1 0000 ERU
Water Meter (SFD) 300 00 300 00 000 o 0000 o 0000
Water Deposit 4000 40.00 000 0.0000 o 0000
Traffic Facilities Charge 757 50 0.00 757 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 0.00 5,41700 5,417 0000 1 0000 ERU
TOTAL FEES. $10,240.96
Appliccmt's Affadavit:
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor I futher certify that I am currently
registered in the State of Washington.
Signature/ ~____ -- _ Date J-/~-".s-
Firm ~ S~
OFFICIAL USE ONLY
# Sets of Prints.
By'
,~;~itJI.$f;._~~~t~~B~]l~~[i!'IE~twif~~~:'~.~.
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CITY OF
YELM
PO Box 479
Yeim. Wi". 90597
360.458-8402
RECEIPT N.) 35905
RECEIVED
****TEN THOUSAND TWO HUNDRED SIXTY NINE DOLLARS & 66 CENTS
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RECEIVED FROM
EVERGREEN STATE BUILDERS
P.O. BOX 39753
LAKEWOOD WA 98499
253-475-6622
15892 104TH AVE SE LOT 60
DATE REC. NO
AMOUNT
REF NO
03/16/05 35905
10,269 66 CHECK
9389
MISCELLANEOUS RECEIPT
JANINE
BLDPER 1306.79,BLDPLN 552 12, MECH 78.75, PLUM PMT 118, SEWINSP 145,
WTRERU 1500 WTRMET 300, CONS DEP 90, TRAF 757 50 SEW ERU 5417 ST BLD FEE 4 5C
RECEIPT
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RECEIVED
****TEN THOUSAND TWO HUNDRED FORTY DOLLARS & 96 CENTS
RECEIVED FROM
DATE
REC NO
A.MOUf\!T
REF NO
EVERGREEN STATE BUILDERS
P.O. BOX 39753
LAKEWWOD WA 98499
253-475-6622
15819 104TH AVE SE LOT 65
03/16/05 35906
10,240 96 CHECK
9389
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MISCELLANEOUS RECEIPT
JANINE
BLD PMT 1276 77,BLDPLNREV 539 44, MECH 78 75, PLM 132, SEW INSP 145 ,
WTR ERU 1500, WTR MET 300, CONS DEP 90, TRAF 757 50 ST BLD FEE 4.50, SEW 5417
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RECEIPT No 35907
RECEIVED
****TEN THOUSAND TWO HUNDRED FORTY DOLLARS & 96 CENTS
RECEIVED FROM
D.ATE
REC NO
AMOUNT
REF NO
EVERGREEN STATE BUILDERS
P O. BOX 39753
LAKEWOOD WA 98499
253-475-6622
15826 104TH AVE SE LOT 49
03/16/05 35907
10,240.96 CHECK
9389
MISCELLANEOUS RECEIPT
JANINE
BLDPMT 1276.77,BLDPLN 539 44, MECH 78.75, PLUM 132 , SERINSP 145 , WTRERU1500
WTR MET 300,CONSDEP 90,TRAF 757 50, STBLDFEE 4 50,SEW ERU 5417 00
Applicant:
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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 2150 S/2 Lot 65
Site Address. 15819 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 805 412-343-80-00
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-05-0083-YL
Phone.
253-475-6622
City' Lakewood
State: WA Zip 98499
Assessor Parcel No. 85840006500
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
-------------
1,276.77 993 75 283.02 5.6000 50.5400 $1,000
539 44 000 0.00 o 0000 o 0000
78.75 000 000 o 0000 o 0000
132.00 2000 112.00 7 0000 16.0000 Fixture
14500 000 145.00 145.0000 1 0000 ERU
1 500.00 000 1,50000 1,500.0000 1 0000 ERU
300.00 300.00 000 0.0000 o 0000
40.00 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
450 450 000 o 0000 0.0000
5,41700 000 5,41700 5,4170000 1 0000 ERU
$10,240.96
PAID
MAR 1 6 2005
CITY OF YELM
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Yelm School District
ATTN' SUSAN CROY
PO BOX 476
YELM, WA 98597
360-458-1900
Sold to: 16755
EVERGREEN STATE BUILDERS LLC
56622
BUILDERS LLC EVERGREEN STATE
5516 75TH ST W #1
LAKEWOOD, WA 98499
# 5808 09 03/16/05
Reg #1 SalesPerson SUSAN
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJECTS
1 @ 10,266.00 10,266.00
\!J2 FOR YELM TERRA LOTS 42,49,54,57
,6 ,65
----------
SubTotal 10,266.00
Total Due
Check
10,266.00
10,266.00
----------
----------
Thank you.
PLEASE KEEP THIS RECEIPT!!!
03/09/2005 13 45
2532843183
o
CASCADE RESIDENTIAL
o
PAGE 04
LOT 65
EVER REENSTATEBUILDERS
YELM TERRA
15819 I04thAVENUE SOUTHEAST
YELM, WA
WATER ~L~J ~ ~=~.- ~- - - - ----. - - - - - ""
STORM LINE -.-~- - - -- --., '"
: 1 04th AVE. SE ("a.,--........" "
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SITE PLAN APPROVAL
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AM'ROVto AS PIltSElII!;O IU Il(VlSE .~o Il!5uRWIT
!lEVlEWEll RY (CI.lmT);
o 60-,
"-
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DATF:
NOTt$;
. SITE PLA ~~'\~:":_.-
_.._~._--- . -
@ 2004 CASCADE RI--SIDENTI~l DESIGN INC
THIS O~AWINt; I~ eASE:D ON ClltJ<T -1'~OVlDEO INrORMATION RrrJrsEIITED TO 9E ACCURATE
AND REllhAlt. AllY I>15CREPANC'ES 9ETWEtII THI~ DRAWING AN~ THE ACTUAL SITE COHDrTIDN~
ARE TJ.lE SOu: REsrOHSISILlTY Or THE ClI[NT. I
@
NORTH
5CALE " ~ 3el'
O ()
ProjectAddress:/..r-$/9 :?".e:f..,....~~v~ ~ Parcel #; MAR 1 0 2005
Subdivision: Ye {Wi. ,..e, (Pi- Lot #. b l)' Zoning; ~ g it --f{J/h11 I 'j
~ew Construdion 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) ,~ --r CUh11 01 R.f. &t du.J I CL (
Project Value: $' 2' Z~. 760
Building Area (sq. ft) 1st Floor U" 2rtd Roar / Z 6 z. Garage ~ fz.. Deck /hO
Basement Carport Patio
# Bathrooms j Heating@OTHER or ELECTRIC (Circle One)
.... ........ ,'~-
.~" \ii' vU
# BedroomsL
Are there any environmentally sensitive areas located on the parcel?
completed environmental checklist must accompany permit application.
If yes, a
ARCHITECTJENGIN
ADDRESS iJ l ~
CITY72lY:8n1a STATE tA/J ZIP t:jx~2
GENERAl CONTRACTOR \~a..s ~ TELEPHONE
ADDRESS EMAll
CITY STATE FAX
CONTRACTORS LICENSE # c~ EXP OAT . CITY LICENSE #
TELEPHONE~J ..5:::~7 go/a CJ
EMAlL
FAX z<:~...536-q~~
EXP DATE CITY LICENSE #
BUILDING OWNER NAME. E
ADDRESS
CITY
ZIP
TELEPHONE
EMAlL
FAX
EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTORS LICENSE #
Copy of mitigation agreement with Yelm Community Schools. if applicable.
I hereby certify thal1he above information is comK:t and that the construction on. and the occupancy and the use of the
above described pIOperty wHI Iba In accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
/ ~___- .5'/O-d>6-
Applicant's Signatu~ Date
Owner I contracto,r~ Contractors Agent (Please cirele one.)
All permits are non-transferable and wilD expire if work authorized by such permit is not begun
within 180 days of issuance, or if work is suspe!1ded or abandoned for a period of 180 days
105 Yelm Avenue West
PO Bo% 419
Yelm. WA 98597
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wo.UB