BLD-05-0080
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euilding Address
Owner Name
owner f'..ddress
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plan Number
eui\ding permit Number
RemarKs.
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f\11 Code Renuired
seotember '\9 2005
Neas \nspected
specia\ conditions
None
Date
eui\dinQ Official
. . \ le(oaliOoa\ Resideolial Code \cnaple(
iniS sl(Uclure is io C()fOpllaoce ~lln ~~: ~o Slale Buildi09 Code couoci\ pursuaol
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CITY OF YELM INSPECTION LOG
PROJECT
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PERMIT NUMBER
ADDRESS
SET BACKS Date
Front 2---l
Rear 5~
Side/FlankIng
Side
5
7
FOOTING REBAR
Date
Comments
FOOTING
o 12"
B 16"
o other
o reqmred vents
WALL REBAR
WALL
o 6"
~ 8"
o other
/tf
Date
COMBINED FRAME/ EXTERIOR SHEAR WALL INSPECTION
Hold downs 0 S e;" Nmhng ~ rf'%' _-
Frame Gas/Propane ~ r {
PlumbIng Mechamcal 0
Comments
INSULA TION
o Gas
o Foam and Seal
Comments
o Electnc
o Vapor barner
o Other
o PVA
SHEET ROCK/SHEAR WALL NAIL
Comments
OTHER
Comments
FINAL
eJ Sewer Final Jf Electncal 0 Civil FInal
7 Address fl InsulatiOn 0 Site Dramage
Comments ()<Lnw \ t~/ Q)1:'
o Landscape Fmal
o Sidewalk
o C of 0
FROM YELM SEWER DEPT
FAX NO 360-458-n166
Sep 14 2005 03 34PM P1
FAX TRANSMISSION
CITY OF Y"ELM
P.O. BOX 479 - 931 NP ROAD NE
YELM, W A 98597
r ,\ 360-458-8411
'() ~ \ '. FAX 360-458-8] 66
TO: &R.~ctE'v DATE: Q-IY-O:)
FAX#:
Fr0111 rg AN D Y
PAGES: I , including this
Cover sheet
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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-05-0080- YL
Issue Date 03/16/2005
(Work must be started within 180 days)
Receipt No
35905
Applicant:
Name: Evergreen State Builders
Phone.
253475-6622
Address. POBox 39753
City' Lakewood
State. WA Zip 98499
Property Information:
Site Address, 15892 104th Ave SE
Assessor Parcel No, 85840006000
Subdivision: Yelm Terra
Lot: 60
Contractor Information:
Name, Evergreen State Builders
Contact: McCullem, Tom
Phone: 253475-6622
Address P.O. Box 39753
City' Lakewood
State: WA Zip' 98499
Contractor License No: EVERGSB980PB
Expires, 10/02/06275
Business License 1042.0
Proje~tll1f.<>rmati()11 :
Project: Yelm Terra
Description of Work: Plan 2229/2, Lot 60
Sq, Ft. per floor (1st) 1038
(2nd) 1191
(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 1,306.79 993 75 313.04 5 6000 55,9000 $1,000
Building Plan Review 552.12 000 0,00 o 0000 o 0000
Mechanical Permit 78,75 000 000 o 0000 0.0000
Plumbing Permit 118.00 2000 98,00 7 0000 14 0000 Fixture
Sewer Inspection 145.00 000 145.00 145,0000 1 0000 ERU
Water ERU 1,500 00 000 1,500.00 1,5000000 1 0000 ERU
Water Meter (SFD) 300,00 300 00 0.00 o 0000 o 0000
Water Deposit 4000 4000 000 o 0000 0,0000
Traffic Facilities Charge 757 50 000 757 50 750 0000 1 0100 Peak PM Trip
Sewer Deposit 5000 50,00 000 o 0000 o 0000
State Building Fee 450 450 000 0,0000 o 0000
Sewer ERU 5,417 00 0,00 5,41700 54170000 1 0000 ERU
TOTAL FEES $10,269.66
Applicant's AffadCivit:
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.
OFFICIAL USE ONLY
# Sets of Prints,
Signature
Date
~-J!J.s'
f
Firm ..t!!FSd
THOUSAND TWO HUNDRED SIXTY NINE DOLLARS & 66 CENTS
RECEIVED FROM
D,~E
REC NO
AMourn
REF NO
EVERGREEN STATE BUILDERS
P.O. BOX 39753
LAKEWOOD WA 98499
253-475-6622
15892 104TH AVE SE LOT 60
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 4.50
RECEIPT No 35906
P.ECEIVED
****TEN THOUSAND TWO HUNDRED FORTY DOLLARS & 96 CENTS
RECEIVED FROM
DATE
REC NO
p.,MOUNT
REF NO
9389
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
MISCELLANEOUS RECEIPT
JANINE
BLD PMT 1276.77,BLDPLNREV 539.44, MECH 78.75, PLM 132, SEW INSP 145.,
WTR ERU 1500. WTR HET 300, CONS DEP 90, TRAF 757 50 ST BLD FEE 4.50, SEW 5417
,~ . m a:.
I-I:~~:~;;H;~~ -CITY OF
\ [/ ~ YELM
~:--..
~ PO Boy 479
, y'elrn, v\/A 95597
,.,yE,!:IM..... 360-458-3403
RECEIPTNo 35907
RECEIVED
****TEN THOUSAND TWO HUNDRED FORTY DOLLARS & 96 CENTS
RECEIVED FROM
DATE
REC, NO
,L\MOUr~T
REF f'JO
EVERGREEN STATE BUILDERS
POBOX 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
SLDPMT 1276.77,BLDPLN 539 44, MECH 78.75, PLUM 132 , SERINSP 145.. WTRERU1500
WTR BET 300,CONSDEP 90,TRAF 757 50. STBLDFEE 4 50,SEW ERU 5417 00
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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 2229/2, Lot 60
Site Address, 15892 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 160001-386-00-00
Sewer ERU 802412-343-50-01
TOTAL FEES.
Permit No BLD-05-0080-YL
Phone:
253-475-6622
City' Lakewood
State, WA Zip 98499
Assessor Parcel No. 85840006000
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
-------------
1,306,79 993 75 313.04 5.6000 55 9000 $1,000
552.12 000 0,00 o 0000 o 0000
78.75 000 0,00 o 0000 o 0000
118,00 2000 9800 7 0000 140000 Fixture
145,00 000 14500 145,0000 1 0000 ERU
1,500.00 0,00 1,50000 1 500 0000 1 0000 ERU
300 00 300 00 000 o 0000 o 0000
4000 4000 000 0.0000 o 0000
757 50 000 757,50 7500000 1 0100 Peak PM Trip
5000 50,00 000 o 0000 o 0000
4.50 4,50 0,00 0,0000 o 0000
5,41700 0,00 5,41700 5,4170000 1 0000 ERU
$10,269.66
PAID
MAR i 6 2005
CITY OF YElM
o
o
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
~ #9392 FOR YELM TERRA LOTS 42,49,54,57
~65
----------
SubTotal 10,266.00
Total Due
Check
10,266 00
10,266.00
----------
----------
Thank you.
PLEASE KEEP THIS RECEIPT!!!
03/Mar 4 20054 5 07PM;3284Prudential Contact CorPASCADE RESIDENTIAL
o 0
No 2246 fP .J/333
LOT ~~
EN STATE BUILDERS
YELM TERRA
16892 04thAVENUESOtrrHEAST
YELM, WA
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CllY Of YELM
RESIDENTIAl BUILDING PERMIT APPLICATJ'-''' FORM
prOjectAddress:A~() /c::::'~~ ~ Parcel#' U
Subdivision: Ye{wt. '7e,rvL Lot#' ~ 6 Zoning; .&lAg If! -ft#1lII'j
~ew Construdion U Re-Modell Re-Roof I Addition U Home Occupation Sign b
u Plumbing u Mechanical U Mobile I Manufactured Home Placement ~ Other l"TeeS.
project Oescri~Scope ofWortc~ ~ Ie -FCUWl' 0 Re ~M, C{.J 414R 0 1ve(
Project Value: 2s~ ~O 82005
Building Area (sq. ft) 1st Floor $../& 2nd Floor //-9/ Garage ~"o Deck
Basement Carport Patio
# Bedrooms-i # Bathroom~~ Heatin~ER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? If yes. a
completed environmental checklist must accompany permit application,
ARCHITECTIENGINEER
ADDRESS .b Z. ~ .
CITY7ZiCbn1a
ZIP t:jx,~Z
BUILDING OWNER NAME. E
ADDRESS
CITY
GENERAL CONTRACTOR \~a.s ~ TELEPHONE
ADDRESS EM~L
CITY STATE FAX
CONTRACTOR'S LICENSE # cf4 EXP OAT . G'il CITY LICENSE #
PLUMBING CONT~~ -/// '>LF-L V).}/JA TELEPHONE~) 537 l?9CJ C)
ADD~~r p EM~L
CITY fa STATELWt zIP98Y~-\ FAX 2<(<:..s:%-9?~
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
ZIP
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby certify that 1he 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.
/~~. ~~-7-t!/S
Applicant's Signatu~ Date
Owner I Contractor . Owner's A~ 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 We8t
PO Box 479
Yelm. WA 98597
(360) 458-3835
(360) 458-3144 FAX
www.cLyelm.wo.wt