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RESIOENilAL CERilflCA iE Of OCCUP ANC'(
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owner Name
Owner ~ddress
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p\an Number
eui\ding permit Number
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FROM YELM SEWER DEPT
FAX NO. 360-458-El166
Sep 06 2005 04 29PM ~1
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TO:
CITY OF YET,M
P.O. BOX 479 - 931 NP ROAD NE
YELM, W A 98597
360-458~84'1 'I
FAX 360-458-8166
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PAGES- l , including this
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From' tAAJOY
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Subject. rituALS / YE"L)'Y) ~L((.f\
COMMENTS 1-.oT LJ~ /)77'1
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++ [1' you do not receive all COplCS or any copy is not legihle, please call (360) 458M8411
as soon as posslb[e.
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CITY OF YELM INSPECTION LOG
PROJECT 'IT
~a1 ~tj
PERMIT NUMBER 0$- OOSCQ-'1 L.
ADDRESS IS'" 7 8 f.Q
( 0 'I ~ S.c. .
SET BACKS Date
F rant zo
Rear ~1"
Slde'Flankmg
SIde
WALL
o 6"
~ 8"
o other
FOOTING
Q 12"
B 16"
o other
o required \ ents
oS
7
FOOTI~G REBAR 11{
Date c-/~-6'~ WALL REBAR ~+{, Date z.-'t.1..- os-
Comments
COJ\1BIi' ED FRAME! E. XTERIOR SHEAR WALL INSPEC~!l)~~
Hold downs ~ Shear Nalllllg 0 ~ --1==
Frame 0 U ~)4=GaSIPropan; it' cJ, 9'/1 ~
Plumbmg fr~-.. _ _~~_ Mechanical 0
I
Comments Utw' b\. t~
I,",Sl LA TION
J Gas
o Foam and Seal
Q Electric
o Vapor barner
Q Other
[] PV;\
Comments
SHEET ROCK/SHEAR ,,, .\LL NAIL
Comments
OTHER
Comments
FI~
.6 S~:er FinacD lectrlcal .0 CI\ II Final
A Address 10SU!Otlop"ge
Comments ' ~
o Landscape FlIlal
o SJde\\ alk
o~
o
o
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0056-YL
I ssue Date 02/16/2005
(Work must be started within 180 days)
Receipt No
35623
Applicant:
Name. Evergreen State Builders
Phone
253.475.6622
Address_ 3815 100th St. SW, Ste. 2A
City' Lakewood
State WA Zip 98499
Pro,perty Information
Site Address. 15786104th Ave SE
Assessor Parcel No 85840004400
Subdivision. Yelm Terra
Lot: 44
Contra ct()rll1fo rmati on
Name. Evergreen State Builders
Contact: McCullem, Tom
Phone 253-475-6622
Address. POBox 39753
City' Lakewood
State WA Zip
Contractor License No EVERGSB980PB
Expires: 10/02/06275
Business License: 1042.0
Project Information:
Project: Yelm Terra
Description of Work: Plan 2200 /2A Lot 44
Sq. Ft. per floor' (1 st) 1172 (2nd) 1028 (3rd) 0 Garage 480 Basement 0
Heat Type (Electric, Gas, Other): GAS
Eees.
Item Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
--------------------------- -------------
Building Permit 100-500k 1,301 19 993 75 307 44 5 6000 54 9000 $1,000
Building Plan Review 549 75 000 0.00 o 0000 o 0000
Mechanical Permit 8475 000 000 o 0000 o 0000
Plumbing Permit 118.00 2000 9800 7 0000 14 0000 Fixture
Sewer Inspection 14500 000 145 00 145 0000 1 0000 ERU
Water ERU 1 500 00 000 1,50000 1,5000000 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 7500000 10100 Peak PM Trip
Sewer Deposit 5000 50.00 000 o 0000 o 0000
State Building Fee 450 4.50 000 o 0000 o 0000
Sewer ERU 5,41700 000 5,41700 5,417 0000 1 0000 ERU
TOTAL FEES $10,26769
Applicant'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.
'~FFleIALUSE ONLY
#- $13tsofPri nts.
Final Inspection.
Signature /' ,II/I?
Firm /.s~#
Date 2' -/tr-,..s'
Date:
By'
Applicant:
o
o
"T\lt~
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
,,~\D
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tt.B
<V Of '-{C \...tJ\
C\\ \
Permit Fees Schedule
Name. Evergreen State Builders
Address. 3815 100th St. SW, Ste. 2A
Project Information
Project: Yelm Terra
Description of Work: Plan 2200 /2A Lot 44
Site Address: 15786 104th Ave SE
Fees
Item Acct Code
Building Permit 100-500k 032001-322-10-00
Building Plan Review 100 001-345-83-00
Mechanical Permit 032 001-322-10-00
Plumbing Permit 032 001-322-10-00
Sewer Inspection 805412-343-80-00
Water ERU 712401-343-80-01
Water Meter (SFD) 712 401-343-80-01
Water Deposit 740402-389-00-00
Traffic Facilities Charge 420120-344-85-00
Sewer Deposit 742402-389-01-00
State Building Fee 160 001-386-00-00
Sewer ERU 802 412-343-50-01
TOTAL FEES
Permit No BLD-05-0056-YL
3L'J (p?- )
Phone.
253.475.6622
City' Lakewood
State. WA Zip 98499
Assessor Parcel No 85840004400
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 0.00 000 o 0000 o 0000
8475 0.00 000 0.0000 o 0000
118.00 2000 9800 7 0000 14 0000 Fixture
145 00 000 14500 145 0000 1 0000 ERU
1,500 00 000 1,50000 1,5000000 10000 ERU
300 00 300 00 000 o 0000 o 0000
4000 4000 000 0.0000 o 0000
757.50 000 757 50 750 0000 1 0100 Peak PM Trip
5000 5000 000 o 0000 o 0000
450 450 000 o 0000 o 0000
5,417 00 000 5,41700 5,4170000 10000 ERU
$10,267.69
RECEIPT No 35623
I RECE!VED
I ****TEN THOUSAND TWO HUNDRED SIXTY SEVEN
Ii EVER;~:E;:D:::~E BUILDERS 0:~:5/05
3815 100TH ST SW #2A
I LAKEWOOD. WA 98499
BLD-05-0056-YL
I SITE: 15786 104TH AVE SE
"
-----_._---_._--~..,.....,
DOLLARS y6~ CENTS '-'\
REC NO / Afv10Um I
313. 10.267,69 C7
! ~_/
/
MISCELLANEOUS RECEIPT
DIANA !
I
REF r~o I
,
!
PENDINGi
I
I
BLDPRMT1301.19, PLNREV549 75, MECHPRMT84 75, PLMBPRMTl18, S/INSP145, W/ERU1500
W/MTR300, W/DEP40, TRAFF757 50, S/DEP50, STFEE4.50, S/ERU5417,
. . !":;.,
. .
:- .~~-_~~__r:- :::G_-T -- ; ~~~!fiit\~iri:~~i~~~~;~~~~~1t
i
I
RECEiPTNo 35624
RECEIVED
****TEN THOUSAND TWO HUNDRED SIXTY SIX DOLLARS & 03 CENTS
R~CE!VE[\ FROM
DArE REe NO
f.;1,10Uf1T
REF hlO
i
i
PENDING;
EVERGREEN STATE BUILDERS
3815 100TH ST SW #2A
LAKEWOOD, WA 98499
BLD-05-0055-YL
SITE 15802 104TH AVE SE
02/15/05 35624
10,266.03 CHECK
MISCELLANEOUS RECEIPT
DIANA
BLDPRMT1299 32, PLNREV548 96, MECHPRMT78 75, PLMBPRMT125, S/INSP145, W/ERU1500
W/MTR300, W/DEP40, TRAFF757 50, W/DEP50, STFEE4 50, S/ERU5417,
--~ =.
:- ' e<. t.'
RECEIPT No '35 E; 2 5
RECEIVED
****TEN THOUSAND THIRTY EIGHT DOLLARS & 41 CENTS
RECEIVED FROf>,1
DAT~
REC NO
6,rvl0Ur~T
FiEF I'KJ
EVERGREEN STATE BUILDERS
3815 100TH ST SW #2A
LAKEWOOD, WA 98499
BLD-05-0054-YL
SITE: 15779 104TH AVE SE
02/15/05 35625
10,038.41 CHECK
PENDING
MISCELLANEOUS RECEIPT
DIANA
BLDPRMT1149.15, PLNREV485 51, MECHPRMT78 75, PLMBPRMT111, S/INSP145, W/ERU1500
W/MTR300, W/DEP40, TRAFF757 50, S/DEP50, STFEE4 50, S/ERU5417
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
# 5751 09 02/16/05
Reg #1 SalesPerson SUSAN
.....-----.........
Item # 2900/MITIGATION ~ ~
MITIGATION/CAPITAL PRECTS )
1 @ 1 , 711. 0 ----.. 1 J 711 00 )
CK #9265 YELM TERRA ~OT #44 ~I
~ /
Item # 2900jMITIGATION '~/
MITIGATION/CAPITAL PROJEe-r-S..._-
1 @ 1,711,00 1 ,711 00
CK #9265 FOR YELM TERRA LOT #45
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJECTS
1 @ 1,711 00 1,711 00
CK #9265 FOR YELM TERRA LOT #70
SubTotal
5 J 133 00
Total Due
Check
5 J 133 00
5, 133.00
----------
----------
Thank you
PLEASE KEEP THIS RECEIPT' I I
Project Address: ~'7,10/~..y~i/e~ parcel#"~5~OOo 4~OQ 7,20,,,,
Subdivisioo: Veo (Wl l-e{ r,;L Lol #: -P'I Zooing; JiM! g 1# --fUthl, / tft;?./ " \,>,
~ew Construction U Re-Modell Re-Roof I Addition U Home Occupation Sign ~ ~ /)
u Plumbing u Mechanical U Mobile I Manufactured Home Placement u Other (f
P~~d_~I~ ~~I<<-I
ProjectValue::- ::ld~/6c!Y._ ~ _ 5cf{ 1-
Building Area (sq. ft) 1st Floorh'7i- 2nd Roor /l!!?zB Garage 1"$0 Deck
Basement Carport Patio
# Bedrooms.L:D4fJV # Bathrooms.z.}o/ 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.
BUILDING OWNER NAME:
ADDRESS
CITY
ARCHllECTJENGINEER
ADDRESS 1/ Z. ~
CITY72lCllYtla STATE U/I ZIP 9X~2
ICENSE #
EMAll
TELEPHONE
GENERAL CONTRACTOR \~ as CJWt-tr TELEPHONE
ADDRESS EMAlL
CITY STATE FAX
CONTRACTORS LICENSE # t:L4 EXP OAT . CITY LICENSE #
PLUMBING ~10R---, -UI ~
ADDRE~f"~ p
CITYJa STAlEU/I
CONTRACTOR'S LICENSE #
TELEPHONEas::?) 5'~7 8"90 CJ
EMAIL
zIP98Y~< FAX 2-):3"s:%-q&~
EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTORS LICENSE #
TELEPHONE
EMAlL
FAX
EXP DATE CITY LICENSE #
ZIP
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby certify that the above information is comJet and that the construction on. and the occupancy and the use of the
above desc:tlbed pIOpIIrty wHl be In accordance with the laws, rules and regulations of the State of Washington and 1he
City ofYelm.
~~ --- ...
~.. -~ 2.. .../..y-~5"""
Applicants Signature - _ Date
Owner J Contractor~er'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 Wat
PO Box 4'l!J
Yelm. WA 98597
-----
(360) 458-3835
(360) 451J..3144 FAX
U1U1U1.I!i.yelm.wo.. WJ
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02/10/2005 17 08 2532g\3183 CASCADE RESJ7-j-"'TIAL
C; I l_
[ LOT 44
EVERdREEN STATE BUILDERS
I
i YELM TERRA
15786 I04th AVENUE SOUTHEAST
YELM, WA
SITE PLAN APPROVAL
PAGE 01
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