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CITY OF YELM - BUILDING DEPARTMENT
RESIDENTIAL CERTIFICATE OF OCCUPANCY
Building Address
15773 1041h Ave. SE
Owner Name
Owner Address
EverQreen State Builders
P.O. Box 39753
Lakewood, WA 98439-0753
Building Permit Number
BLD-05-0059- YL
Plan Number
2229/2
Remarks.
Areas Inspected
All Code Required
Special Conditions
None
Building Official
G Carlson
Date
September 29, 2005
This structure is in compliance with the International Residential Code (Chapter
51-51 WAC) as adopted by the Washington State Building Code Council pursuant
to Chapters 19.27 and 70 92 RCW, effective July 1, 2004
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FROM YELM SEWER DEPT
FAX NO 360-458-E3166
Sep 29 2005 09 56AM Pi
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FAX TRANSMISSION
CITY OF YEL~A
P.O. BOX 479 - 931 NP ROAD NE
YELM, W A 98597
360-458-8411
FAX 360-458-8]66
DATE: q-;lCJ... 0",:)
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Subject: 'f::. \tU.AL / ~am ~R.A
COMMENTS LoT I ~ 1')773 )D41l! Aui;. $. E".
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CITY OF YELM INSPECTION LOG
PROJECT~ r ~~ 7/
PERMIT NUMBER~Lb
I
ADDRESS I 5 7 7 '7
~() C; ~O ()-5t - Y (-
fO-~~~\,^,~ 5~
SET BACKS Date
Front 2.0
Rear 30
Slde'Flanklng 7
Side ~
WALL
o 6"
'8 8"
o other
FOOTING
o 12"
-S 16"
o other
o required vents
FOOTI~G REBAR
Date
W.\LL REBAR
Date
Comments
COMBINED FRAME/ EXTERIOR SHEAR WALL INSPECTION
I, Hold downs ~] ~ fM ~.11 fp{ Shear NailIng Y ~ SJ~3.
\l\;{( 2\W Frame )21, Lw- -7/1~' I Gas/Propane ~/cn<. 114/
it'" Plumbing ~ 1 Mechanical 0
F e ~!M"'" \'Jvp,.c,.. ,,\,~ \ 1!if { J
Comments /)vv- ~w...L- I pm/ (:/9'(' Yft ~ r ~ f'
I'\'Sl LA TION /' Gas [] ElectrIC 0 Other
. [fVfoam and Seal ~PQr barner yPV -\
C ommen!s ~V^/ 7/ >r?Jj/
SHEET ROCK/SHEAR '''ALL NAIL
comments~3
OTHER
Comments
( FINAL
~ Sewer Final
~ Address
Comments
t ElectrIcal
. r InsulatIon
l~ ~ CfMi
o 0\'11 Fmal 0 Landscape Flnal
o Site Dramage 0 Sldev-;alk ct. r1
J... q/ry()~
o C of 0
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0059- YL
Issue Date. 03/02/2005
(Work must be started within 180 days)
Receipt No
35791
Applicant:
Name. Evergreen State Builders
Phone.
253-475-6622
Address. P.O Box 39753
City' Lakewood
State. WA Zip 98499
Pr()perty Information:
Site Address. 15773 104th Ave SE
Assessor Parcel No 85840007100
Subdivision. Yelm Terra
Lot: 71
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
Project Information
Project: Yelm Terra
Description of Work: Plan 2229/2, Lot 71
Sq. Ft. per floor. (1st) 1038
(2nd) 1191
(3rd) 440
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 1,306.79 993.75 313.04 5 6000 55 9000 $1,000
Building Plan Review 552.12 000 000 o 0000 o 0000
Mechanical Permit 78.75 0.00 000 o 0000 o 0000
Plumbing Permit 118.00 20.00 98.00 7 0000 14 0000 Fixture
Sewer Inspection 145.00 000 145.00 145.0000 1 0000 ERU
Water ERU 1,500.00 0.00 1,500.00 1,500 0000 1 0000 ERU
Water Meter (SFD) 300 00 300 00 000 o 0000 o 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 5000 50.00 000 0.0000 o 0000
State Building Fee 450 450 0.00 0.0000 o 0000
SewerERU 5,41700 000 5,41700 5,4170000 1 0000 ERU
TOTAL FEES $10,269.66
AppliC::Clllt's Affadavit:
OFFICIAL USE ONLY
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor, I futher certify that I am currently
registered in the State of Washington,
Signature/~ ~ Date 3-Z.-~
Firm ---$ /$' .
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RECEIPT No 35791
CITY OF YELM
REr.EIVED
****TEN THOUSAND TWO HUNDRED SIXTY NINE DOLLARS & 66 CENTS
RECEiVED FROM
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD, WA 98499
BLD-05-0059-YL
SITE 15773 104TH AVE SE
DATE
03/02/05
REe ~~o
AMOUNT
REF NO
35791
10,269 66 CHECK
PENDING
MISCELLANEOUS RECEIPT
JANINE
BLDPRMT1306 79,BLDPLREV552 12, MECHPRMT78 75, PLMBPRMTl18, S/INSP145,
W/ERU1500, W/HTR300, W/DEP40, TRAFF757 50, W/DEP50, STFEE4.50. W/ERI5417
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City of Yelm
Community Development Department
Building Division
Phone. (360) 458-8407
Fax: (360) 458-3144
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PAID
MAR 0 2 Z005
CITY OF YELM
Permit No BLD-05-0059-YL
Applicant:
Name: Evergreen State Builders
Address: P O. Box 39753
Project Information
Project: Yelm Terra
Description of Work: Plan 2229/2, lot 71
Site Address. 15773 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 Fees Schedule
Phone:
253-475-6622
City. lakewood
State: WA Zip 98499
Assessor Parcel No. 85840007100
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 0.00 000 0.0000 o 0000
78.75 0.00 0.00 0.0000 0.0000
118.00 20.00 98.00 7 0000 14.0000 Fixture
145 00 000 145.00 145.0000 1 0000 ERU
1,500.00 0.00 1,50000 1,500.0000 1.0000 ERU
300 00 300.00 000 0.0000 o 0000
4000 40.00 0.00 0.0000 o 0000
757.50 0.00 757.50 750.0000 1 0100 Peak PM Trip
5000 50.00 000 0.0000 o 0000
4.50 4.50 0.00 o 0000 o 0000
5,417.00 0.00 5417.00 5,417 0000 1 0000 ERU
$10,269.66
CITY OF VElM
RESIDENTIAL BUILDING PERMIT APPUCA:r."QN FORM
n 7'4 s./ { ~ ell "(J 0 7 Ic()
ProjectAddress:--(S/\. ,lr /t:J~ A-lIe/'''::- Parcel#" ~ D 10
Subdivision: Yefh/l -Ur('PL Lot#. I L Zoning; ~~ /.e --ft-flh1/ /'j
hew 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 Descri~nIScope of Work:~ 1/e .(atY'l1 ~ f!e 6/ dull CL (
Project valu~,(?~ 750 I '7 5( l' 0
Building Area (sq. ft) 1st Floor/t>J);' 2nd Floor // ? / Garage 1/~ (:) Deck
Basement Carport Patio Z,/ ~
# BedroomsL # Bathrooms z..s;- Heating@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.
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ARCHITECTIENGINEER
ADDRESS i? 2. ~ .
CITY72lClJn1a
ICENSE #
EMAll
ZIP 9x.~2. TELEPHONE
BUILDING OWNER NAME. E
ADDRESS
CITY
GENERAl CONTRACTOR \"I:hM a.s CI71Nr TELEPHONE
ADDRESS EMAIL
CITY STATE FAX
CONTRACTOR'S LICENSE # c:L/ EXP OAT . t:IO CITY LICENSE #
PLUMBING CONT~~U1V'T" '0';111..1 TELEPHONE~)~~7 8"9tJ C1
ADD~~8'/r P EMAIL
CITY fa n1 STATEU/f zIP98Y~" FAX 2<.:.;'~-q?~
CONTRACTOR'S LICENSE # EXP DATE CITY L1<;;ENSE #
ZIP
TELEPHONE
EMAll
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 the occupancy and the use of the
above described property wUJ be In accordance with the laws, rules and regula dons of the State of Washington and the
City ofYelm.
~M-~ :?-Z/-~S-
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 pennit is not begun
within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days
105 Yelm Avenue Weat
PO &Ix 479
Yelm. WA 98597
(360) 453-3835
(360) 458-3144 FAX
www.ci.yelm.wlJ._
Feb 21 2005 9 48AM
Prudential Contact Corp
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LOT 11
EVERGREEN STATE BUILDERS
YELM TERRA
YELM, WA
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