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owner Name
owner Address
p\an Number
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Bui\ding p...ddress
Bui\ding permit Number
Remar\r.s.
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N\ Code Reauired
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CITY OF YELM INSPECTION LOG
PROJECT
Lo+ ~7 '--/ ~Lp\ J;.{'<'~
WALL
o 6"
o 8"
o other
'W
Date
PERMIT NUMBER
(:;?.s:-- (-:;>0 (1../ - i..J L-
Comments
IJ Other
o PVA
Comments
Comments
o La2fPpe Fmal,Aofo
o Slr.v['~
ADDRESS
I ~'blY
1..1 8'\ . . I L':t:
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SET BACKS Date
Front 1. 0' 1Y\"; ~ '8'" (.....--
Rear Z-u
Slde'Flankmg -f;
SIde r;
FOOTING
[] 12"
o 16"
o other
o requIred vents
FOOTI~G REBAR
Date
WALL REBAR
COl\lBll'ID FRAME/ EXTERIOR SHEAR WALL INSPECTION
Hold downs 0 _._ ~ Shear Nallmg J/ ~1
Frame 0 ~ $ It Gas/Propane ji
Plumbmg 1 _ L") Mechamcal []
Comments Au ^~\~""
I~Sl LA TION
J Gas
o Foam and Seal
[] Electnc
[J Vapor barner
SHEET ROCK/SHEAR \V .\LL NAIL
comments~~
OTHER
FINAL l'
J Sewer Final # Electncal [] CIvIl Fmal
W Address 'f'iVSlle Dramage
comments~'3'.. .
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-007 4- YL
Issue Date 03/16/2005
(Work must be started within 180 days)
Receipt No
35902
Applicant:
Name: Evergreen State Builders
Phone.
253-475-6622
Address. POBox 39753
City' Lakewood
State. WA Zip 98499
Property Information:
Site Address. 15874 104th Ave SE
Assessor Parcel No. 85840005700
Subdivision. Yelm Terra
Lot: 57
Contractor Information:
Name Evergreen State Builders
Contact: McCullem, Tom
Phone: 253-475-6622
Address. POBox 39753
City' Lakewood
State. WA Zip 98499
Contractor License No EVERGSB980PB
Expires. 10/02/06275
Business License: 1042.0
i=>f()ject Informati()n.
Project: Yelm Terra
Description of Work: Plan 1530 S/2, Lot 57
Sq Ft. per floor' (1st) 1530
(2nd) 0
(3rd) 582
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 1,069 91 993.75 7616 5.6000 13 6000 $1,000
Building Plan Review 452.03 000 000 o 0000 o 0000
Mechanical Permit 7175 000 0.00 o 0000 0.0000
Plumbing Permit 111 00 20.00 9100 7 0000 13.0000 Fixture
Sewer Inspection 145 00 000 145.00 145 0000 1 0000 ERU
Water ERU 1,50000 000 1,500.00 1,5000000 1 0000 ERU
Water Meter (SFD) 300 00 300 00 0.00 o 0000 o 0000
Water Deposit 4000 4000 0.00 o 0000 0.0000
Traffic Facilities Charge 757 50 000 757.50 750 0000 1 0100 Peak PM Trip
Sewer Deposit 5000 5000 000 o 0000 0.0000
State Building Fee 450 450 000 o 0000 0.0000
Sewer ERU 5,41700 000 5,41700 5,4170000 1 0000 ERU
TOTAL FEES. $9,918.69
Applicant'.!> 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 ../-:/ tIt"........--.
Firm ~S~
OFFICIAL USE ONLY
# Sets of Prints.
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--..-. - .-.---.--.. -.
v- ~~ _-- ~- ';ri-';-.='"
" . .
RECEIVED
****NINE THOUSAND NINE HUNDRED EIGHTEEN DOLLARS & 69 CENTS
RECEIVED F~OM
DATE
REC. NO
f\iv10UNT
REF 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
o D'.
RECEIPT No
35903 ~
RECEiVED
****NINE THOUSAND NINE HUNDRED FORTY EIGHT DOLLARS & 55 CENTS
RECEiVED FROM
DATE
REC NO
AMOUNT
REF ~W
EVERGREEN STATE BULDERS
POBOX 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 HET300,
CONS DEP 90, TRAF 757 50, BLD FEE 4 50, SEW ERU 5417,
. .... it:" .. 0
_.-0 . _~ __.. ~. .
~; of TH€ p+:}! CITY 0 F
F -"f; YELM
~ PO Box 479
)elm. ViA 98597
..YE!-,~,.O" 360-458-8403
RECEIPT No 35904
REC;:EIVED
***TEN THOUSAND TWO HUNDRED SIXTY SEVEN DOLLARS & 69 CENTS
RECEIVED FROM
DATE
REC NO
AMOUNT
10,267.69 CHECK
REF NO
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
9389
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.
o
o
Per-n,ltFees Schedul~
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 1530 S/2, Lot 57
Site Address. 15874104th Ave SE
Fees. .JI
Item Acct Code
--------------------------- --------------
Building Permit 100-500k 032 001-322-10-00
Building Plan Review 100001-345-83-00
Mechanical Permit 032 001-322-10-00
Plumbing Permit 032 001-322-10-00
Sewer Inspection 805 412-343-80-00
Water ERU 712401-343-80-01
Water Meter (SFD) 712 401-343-80-01
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 802 412-343-50-01
TOTAL FEES
Permit No BLD-05-0074-YL
City' Lakewood
Phone: 253-475-6622
State: WA Zip 98499
Assessor Parcel No. 85840005700
Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
-------------
1,06991 993.75 76.16 5.6000 13 6000 $1,000
452.03 000 0.00 o 0000 o 0000
7175 000 0.00 o 0000 o 0000
111 00 2000 9100 7 0000 13 0000 Fixture
14500 000 145.00 145.0000 1 0000 ERU
1,50000 000 1,50000 1,5000000 1 0000 ERU
300.00 300.00 000 o 0000 0.0000
40.00 4000 000 o 0000 o 0000
757.50 0.00 757 50 750 0000 1 0100 Peak PM Trip
50.00 50.00 000 0.0000 0.0000
4.50 450 000 o 0000 o 0000
541700 000 5 417 00 5,417 0000 1 0000 ERU
$9,918.69
PAID
MAR 1 6 2005
CITY OF YELM
o
o
Yelm School District
ATTN: SUSAN CROY
PO BOX 476
YELM, WA 98597
360-458-1900
Sold to: 16755
EVERGREEN STATE BUILDERS LLC
56622
BUILDERS LLC EVERGREEN STATE
5516 75TH ST W #1
LAKEWOOD, WA 98499
# 5808 09 03/16/05
Reg #1 SalesPerson SUSAN
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJECTS
1 @ 10,266.00 10,266.00 ~
CK #9392 FOR YELM TERRA LOTS 42,49,54,57
,60,65
SubTotal
10,266.00
Total Due
Check
10,266.00
10,266.00
----------
----------
Thank you.
PLEASE KEEP THIS RECEIPT!!!
.3tMal 4 1005. 5'07~Mc::>~!'~.ntlal Contact COIPOSCADE RESc==rTlAL
No 2246 IP J/3!l2
LOT 5>1
EN STATE BUILDERS
YELM TERRA.
18874 04thAVENUESOU'J.'HEAST
YELM, WA
SITE PLAN APPROVAL
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Mil:
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NO~TJ1
e 2004 CASCAOE RESll,)ENTlAI. OE:SIGN. INe
SCALE I" " 30'
- OllA_O I!; W[/l 11I/ OoIt11'l-PllO\'lDCO /IlIDllIIlI1ICI1f ~ tit 10 U ~7t
- 1If;\f4Sl.E. II"': ~"IlCCt ~ 1Ml$ llIIl\._ _110 AI:l'.w. Stlt _molll'!:
....~ 1IIt sou: ~ et tIIIl
CITY OF VElM
RESIDENTiAl BUILDING PERMIT APPUCr-'\)N FORM
Project AddreSS:/--.rL)~ /~~ ~ Parcel #' ~)
Subdivision: Ye{'wt --ref(~ Lot#. C7 Zoning; ..&U1.0/t! -/{Vh1II'J ~
~ew Construction U Re-Modell Re-Roof I Addition U. -Home Occupation Sign <Y ~
U Plumbing U Mechanical U Mobile I Manufactured Home Placement U Other ~ t'~
project DescripScope of WOrk:~ -:J ie -FaA7lt (:} R.e f;;,( duJ-t <Z. { '11' Q d' Vt..($!
Project ValuF Z t!J J')r ~ <"b0' QI
Building Area (sq. ft) 1st Floor L.(JO 2nd Floor Garage l r~Z Deck
.
Basement Carport Patio Vb
# Bedroomsi # Bathrooms """t...-- Heatin~OTHER 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 L ~ .
CITY72lCtm1a STATE U/l ZIP 9tf~z
GENERAL CONTRACTOR \~ as 071fl..tr TELEPHONE
ADDRESS EMAIL
CITY STATE FAX
CONTRACTORS LICENSE # t:~ EXP DA T . CITY LICENSE #
PLUMBING CONTRACJOR..J
ADDRESS ~/'... -~~
CITY /2l Yl1 STATE u.
CONTRACTOR'S LICENSE #
TELEPHONE~)537 /?tj'tJ 0
EMAIL
'YS FAX 2<.~~-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 1he occupancy and the use of the
above deac:ribed property will be In accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
/~~ .5v7-'~cS-
Applicant's Si9natu~ 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
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wo_ua
105 Yelm Avenue Wellt
PO Box 479
Yelm, WA 98597