BLD-05-0075
CIT'f Of 'fE\.M _ 6U1\.OING OEP ~RTMENT
RESIOENTI~\. CERTlfIC~TE Of OCCUp~NC'f
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CITY OF YELM INSPECTION LOG
PROJECT
kr lt2- '/T
PERMIT NUMBER
t:> 5'"- c/o 7 ~
1577 i.f j 04 u- /.J.v-t' ~t!
ADDRESS
SET BACKS Date
Front 2-0
Rear ~7
Slde'FlanJ....mg 1"
Side /1
FOOTING
~ 12"
0---1 6"
o other
o required vents
WALL
o 6"
fB- 8"
o other
lip
FOOTING REBAR
Date
WALL REBAR
Date
Comments
CO!\1BIJ\ED FRAME/ EXT~IOR SHEAR WALL INSPECTION
Hold dO\\ns ~~ ~hear Nailmg ;6 ~JL/
Frame /t --Wv1JJV' ?aslPropanel'::J __ &1/ ,
Plumbmg 'I ", tt Mechamcal 0 I
comments~ btrv~/ /:)1:,<: ,J-. ~..../
I~Sl LA TlON fl' yas ~ Electnc 0 S>R'er
'p/Foa7nd Seal 0 Vapor barner ~V-\
Comments ~'I~&\
SHEET ROCK/SHEAR \VALL NAIL
Comments ^..Ik1 t h l/os
~I
OTHER Comments
FINAL
~. Sewer Final
., Address
'I Electncal
fJ Insulation
o Civil Final 0
o Site Dramage
Comments
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FROM YELM SEWER DEPT
Fi=lX NO, 360-458-El166
Sep 05 2005 04 29PM Pi
FAX TRANS'MISSION
TO.
CITY OF YFI, \1
po. BOX 479 - 931 NP ROAD NE
YELM, W A 9:~597
360-458-8411
FAX 360-458-8"[ 66
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DATE 1-~-o~
FAX#.
PAGES' [ , including this
Cover sheet
From: ~AAJ{)Y
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Subject. F\UAL5/YELrn --mqc.f)
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COMMENTS: L-oT L{ ~ /5'"77(( I DL/!11 f-ll)~. S. c:: I ':5 -5'-1), " L
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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-05-0075-YL
Issue Date. 03/16/2005
(Work must be started within 180 days)
Receipt No
35904
AppliC;Cll'lt:
Name: Evergreen State Builders
Phone:
253.475.6622
Address, 3815 100th 51. SW, Ste. 2A
City' Lakewood
State. WA Zip 98499
Property Information:
Site Address. 15774 104th Ave SE
Assessor Parcel No. 85840004200
Subdivision: Yelm Terra
Lot: 42
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 Il'lf()rmation"
Project: Yelm Terra
Description of Work: Plan 2200 /2A Lot 42
Sq. Ft. per floor' (1st) 1172
(2nd) 1028
(3rd) 480
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 1,30119 993.75 307 44 5.6000 54 9000 $1,000
Building Plan Review 549 75 000 0,00 0.0000 o 0000
Mechanical Permit 8475 0.00 000 o 0000 o 0000
Plumbing Permit 118,00 2000 98.00 7 0000 14 0000 Fixture
Sewer Inspection 14500 000 145.00 145 0000 1 0000 ERU
Water ERU 1,50000 000 1,500 00 1,5000000 1 0000 ERU
Water Meter (SFD) 300,00 300 00 000 o 0000 o 0000
Water Deposit 4000 4000 0.00 o 0000 o 0000
Traffic Facilities Charge 757.50 000 757.50 750 0000 1 0100 Peak PM Trip
Sewer Deposit 5000 5000 0.00 o 0000 o 0000
State Building Fee 4.50 450 0.00 o 0000 o 0000
Sewer ERU 5,41700 000 5,41700 54170000 1 0000 ERU
TOTAL FEES. $10,267.69
Applic;al'lt's Affadavit:
OFFICIAL USE ONLY
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record, If applying as a contractor, I futher certify that I am currently
registered in the State of Washington.
Signature / ~ Date J-/~ -45'
~~~
Firm ... f11J'V
# Sets of Prints:
Final Inspection:
Date:
By'
.,~:~'. ~ ._1 _~..'
~~tNfiSiif}fJ:!~'~r
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RECEIPT No
35902 -t{
RECEIVED
****NINE THOUSAND NINE HUNDRED EIGHTEEN DOLLARS & 69 CENTS
RECEIVED FROM
DATE
REC NO
AMOUNT
FiEF NO
EVERGREEN STATE BUILDERS
POBOX 39753
LAKEWOOD WA 98499
253-475-6622
BLD050074YL
03/16/05 35902
9,918 69 CHECK
9389
MISCELLANEOUS RECEIPT
JANINE
EVERGREEN STATE BUILDERS # BLD-05-0074-YL
.~~~~11~~~I~~?_1ftt~";ml~~r.~'.;' ~ a~-3 .~_=.. ~_. =9 ._~.'
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RECEIPTNo 35903 ~
RECEIVED
****NINE THOUSAND NINE HUNDRED FORTY EIGHT DOLLARS & 55 CENTS
RECEiVED FROM
DATE
REG NO
AMOUNT
REF ~~O
EVERGREEN STATE BULDERS
P.O. BOX 39753
LAKEWOOD WA 98499
253-475-6622
15856 104TH AVE SE LOT 54
03/16/05 35903
9,948 55 CHECK
9389
MISCELLANEOUS RECEIPT
JANINE
BLDER 1090 90,BLDPLNREV 460.90, MECH 71 75, PLUM 111, WTR ERU 1500, W MET300,
CONS DEP 90, TRAF 757 50, BLD FEE 4 50, SEW ERU 5417.
_=.....0- . -" '''''-__'''.= . '.~ - >. ..--"".:...-.....;-.;~ _C_"'"
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II ...::"'... .._.0 .
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-.'. He' .'}c~~~ro:'>t?t;%\~tZ~;;~~i;~;$'1?1'
RE~EiVED
***TEN THOUSAND TWO HUNDRED SIXTY SEVEN DOLLARS & 69 CENTS
REF NO
RECEIVED FROM
DATE
REG NO
AMOUNT
10.267 69 CHECK
9389
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EVERGREEN STATE BUILDERS
3815 100TH SAT SW STE 2A
LAKEWOOD WA 98499
253-475-6622
15774 104TH AVE SE LOT 42
03/16/05 35904
MISCELLANEOUS RECEIPT
JANINE
BLDPER1301.19,BLDPLNREV 549 75,MECH 84 75, PLUM 118, SEWINS 145, WTR ERU 1500
WTR MET 300, DONS DEP 90, TRAF 757 50, SEW ERU 5417,
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City ofVelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: Evergreen State Builders
Address. 3815100th St. SW, Ste. 2A
Project Information:
Project: Yelm Terra
Description of Work: Plan 2200 /2A Lot 42
Site Address, 15774104th 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-05-0075-YL
City' Lakewood
Phone. 253.475.6622
State: WA Zip 98499
Assessor Parcel No. 85840004200
Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
-------------
1,30119 99375 307 44 5 6000 54.9000 $1,000
549 75 000 000 o 0000 o 0000
8475 000 000 o 0000 o 0000
118.00 2000 98.00 7 0000 14 0000 Fixture
14500 000 145.00 145 0000 1 0000 ERU
1,50000 000 1 500 00 1,5000000 1 0000 ERU
300 00 300 00 0.00 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
450 4,50 000 o 0000 0.0000
5,41700 000 5,41700 5,4170000 1 0000 ERU
$10,267.69
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.~0
CK #9392 FOR YELM TERRA LOT~49,54.51
.60.65
SubTotal
10.266.00
Total Due
Check
10,266.00
10.266.00
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Thank you.
PLEASE KEEP THIS RECEIPT!!!
m 03/04/2005 16.34
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..
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2532843183
CASCADE RESIDENTIAL
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PAGE 01
LOT 42
REEN STATE BUILDERS
YELM TERRA
04th AVENUE SOUTHWEST
YELM, WA
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SITE PLAN _APPROVAL
APPIlOYtD All PllI:SOITDI IItVISt AND IlESlI81llt
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e 2005 CASCADE RESI()ENTI L DESIGN, INC.
TIllS D/lAWfNC l!l U,l!:hl ON CLIENT-PROVIDED 'NFO"lIATION liE RESENTF,O TO BE ACCURATE
"NO /lWABLE. ANY DISCREPANCIES BtTWEF,N nlls O""WINC ^ D TlfE ACIUj\~ Silt CONDITIONS
ARt tHE SOLE RtSPDNSUlIUTY or THe CUENT,
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CITY OF YELM
, RES~EN~ B~lDING PERMIT APPUCAO FORM
Project Address: I~'-::J.C../l /0 Y 4.Jf. S:. i..J. Parcel tt
Subdivision: Ye>Ih1 -Urf'Pl Lot#. $12.. Zoning; .&u1g It! --/{#rtll'j
~ew Construction U Re-Modell Re-Roof I Addition U Home Occupation Sign
U Plumbing U Mechanical U Mobile I ~anufa~Ured Home Placement ~ Other ~
Project Description/Scope OfWOrk:~ fJ I~ -FaA1Ill 0 ~ uduJ-lccl ~ (S)c
Project value:-f" ,;2.. ~ y 9 S' 0 . ~ . ~1' Q ~h
BuildingArea(sq.ft) 1$lFloor/('""tL 2ndFloor/".:LY' Garage YYD Deck t9d (91""V
Basement Carport Patio ~ V-
# Bedrooms .:3. # Bathrooms .2._ <:l Heating:~THER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
completed environmental checklist must accompany permit application.
If yes, a
ARCHITECTIENGINEER
ADDRESS JJ Z. ...:Q;
CITY7ZlClJn1a STATE ~ ZIP'1~>02.
GENERALCONTRACTOR \~a.s ~ TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # t.:14 EXP OAT 'a CITY LICENSE #
BUILDING OWNER NAME. E
ADDRESS
CITY
TELEPHONE~7 ~"37-1?9cJ CJ
EMAIL
zIPlf'8Y!I< FAX 2<:<;>..5%-9?~
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 the above Information is correct and that the construction on. and ~ occupancy and the use of the
above described property wUJ be In accordance with the laws, rules and regulations of the State of Washington and the
City ofYelm.
JA A,-C
Daht /
Contractor's Agent (Please circle one.)
All rmits 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 West
PO Box 479
Yelm, WA 98597
(a60) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wo.us