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CIT'( Of '(E\.f'A _ 8UI\.OIl'lG OEl' "RTf'AEl'lT
RESIOEl'lTI"\. CERTlfIC" TE Of oCCUl' "l'lC'(
Building ,...daress
~
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owner Name
owner p..ddress
plan Number
22'\'\/2
Building permit Number
1\11 coae ReQuired
Remar"s
--
p..reas Inspected
~
None
oate
special conditions
Building Oificial'
. . I e Inlernational Residential Code (Cnapler
inlS slruclur. is in compl,.nce ~~n nn I n 51ale auildlng Code Counc~ pUlSuanl
5'\-5'\ Wp..C) as adopted b'J tn7e ~~;;~ZoRCIN el\eC,IVe JUW " ZOM
\0 cnapters '\ 9 2 anu '
G. carlson
FROM YELM SEWER DEPT
FAX NO 360-458-tl166
Jul 26 2005 03 46PM Pi
FAX TRANS'MISSION
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CITY OF YEL'vi
P.O. BOX 479 - 931 NP ROAD NE
YELM, WA 9:)597
360-458-g41 A
FAX 360-458-8166
EN
DATE: 7 - ;;.~~ D~-
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FAX#.
PAGES: I , mcluding this
Cover sheet
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COMMENTS )L D T '-1")/ 1-s''l6? I D y1)l Au E, "5-; .ftVEfI./,l?Ec P 11 ,:
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From. ~MOY
Subject: p \ :VAL / Y ELW\ 'c1~J(A
CD ""~Cl ~ T l-b W\ ,S
H If you do not receIve all copies or any copy IS 110t legible, pkase call (360) 458-R411
as soon as possible
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CITY OF YELM INSPECTION LOG
PROJECT
yT ~o~ '-I~
PERMIT NUMBER O~- CO $"5 -Y L
ADDRESS I S--rr () ~ I () <f Th ~ S.~.
SET BACKS Date
Front z.~
Rear 57 9
Slde'Flankmg S
SIde 7
WALL
o 6"
'8 8"
o other
FOOTING
o 12"
'B 16"
o other
o reqUIred, ents
FOOTING REBAR "3'J!. Date clCo- (\ ~ WALL REBAR ~, Date <'-2.1.-03"'
Comments
COJ\1BIJ\ED fRAME! EXTERIOR SHEAR WALL INSPECTION
Hold downs 0, Shear NaIlIng 0
/' ~,
Frame ,J,; L~'~I GaslPropane 21~ fJ1
PlumbIng l' J~ Mechanical 0
Comments ~l~ 0..1 r\~
l'I\Sl1LA TI0N
u Gas
o Foam and Seal
[] Electnc
o \' apor barner
[] Other
o PVA
Comments
SHEET ROCK/SHEAR \VALL NAIL
Comments
OTHER
Comments
FINAL
i Sewer Final ;I' Electrical
~ Address ~ InsulatIon
Comments &nl)llJu~
o CIvIl FInal
o SIte DraInage
o Landscape FInal
o SIdewalk
o coro
o
o
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0055- YL
Issue Date 02/16/2005
(Work must be started within 180 days)
Receipt No
35624
Applicant:
Name. Evergreen State Builders
Phone
253.475.6622
Address. 3815 100th St. SW, Ste. 2A
City' Lakewood
State WA Zip 98499
PrQpertylnformation.
Site Address, 15802104th Ave SE
Assessor Parcel No 85840004500
Subdivision: Yelm Terra
Lot: 45
Cbntractor'"rnformation
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
PrQject Information
Project: Yelm Terra
Description of Work: Plan 2211/2, Lot 45
Sq Ft. per floor" (1 st) 1071 (2nd) 1140 (3rd) 0 Garage 434 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 1,29932 99375 305 57 5 6000 54 5660 $1,000
Building Plan Review 548 96 000 000 o 0000 o 0000
Mechanical Permit 78.75 000 000 o 0000 o 0000
Plumbing Permit 125 00 2000 105.00 7 0000 15 0000 Fixture
Sewer Inspection 145 00 000 145.00 145 0000 1 0000 ERU
Water ERU 1 500 00 000 1,50000 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 7500000 1 0100 Peak PM Trip
Sewer Deposit 5000 5000 000 o 0000 0.0000
State Building Fee 450 450 000 0.0000 o 0000
SewerERU 5,41700 000 5,41700 5,417 0000 1 0000 ERU
TOTAL FEES $10,266.03
Applicant~s Affac!~vit:
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 2.,.-'4-'- "".I""
Firm ~.s~
OFFICIALLJSE ONLY
# Sets of Prints:
Final Inspection
:t!:I"r-
o
o
'~11A\
Permit Fees Schedule
City of Yelm
Community Development Department
Building Division
Phone (360) 458-8407
Fax: (360) 458-3144
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Applicant:
Name. Evergreen State Builders
Address 3815 100th St. SW, Ste. 2A
Projec:tflnformation.
Project: Yelm Terra
Description of Work: Plan 2211/2, Lot 45
Site Address, 15802 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 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 160 001-386-00-00
Sewer ERU 802 412-343-50-01
TOTAL FEES
Permit No BLD-05-0055-YL
Phone
253.475.6622
City' Lakewood
State, WA Zip 98499
Assessor Parcel No 85840004500
Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
-------------
1,299 32 99375 30557 5 6000 54 5660 $1,000
548 96 000 000 o 0000 o 0000
7875 000 000 o 0000 o 0000
12500 2000 1 05 00 7 0000 15 0000 Fixture
14500 000 145 00 145 0000 1 0000 ERU
1,50000 0.00 1,50000 1,5000000 1 0000 ERU
300 00 300 00 000 o 0000 o 0000
4000 4000 000 o 0000 o 0000
757 50 000 757 50 7500000 1 0100 Peak PM Trip
5000 5000 000 o 0000 o 0000
450 450 000 o 0000 o 0000
5,41700 000 5,41700 5,417 0000 1 0000 ERU
$10,266.03
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RECEIPT No 3 5623
RECEIVED
****TEN THOUSAND TWO HUNDRED SIXTY SEVEN DOLLARS & 69 CENTS
RECEIVED FROM
EVERGREEN STATE BUILDERS
3815 100TH ST SW #2A
LAKEWOOD, WA 98499
BLD-05-0056-YL
SITE 15786 104TH AVE SE
DATE
REC NO
AMOUNT
REF NC
02/15/05 35623
10,267.69 CHECK
PENDING!
!
MISCELLANEOUS RECEIPT
DIANA
BLDPRMT1301.19, PLNREV549 75, MECHPRMT84 75, PLMBPRMT118, S/INSP145, W/ERU1500
W/MTR300, W/DEP40, TRAFF757.50, S/DEP50, STFEE4 50, S/ERU5417,
- D e'~
RECEIVED
****TEN THOUSAND TWO HUNDRED
F!ECEI\iE[\ FRniv1
EVERGREEN STATE BUILDERS
3815 100TH ST SW #2A
LAKEWOOD, WA 98499
BLD-05-0055-YL
SITE 15802 104TH AVE SE
: '
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_.- -....-..-.--.. -- -
RECEIPT No 35624
SIXTY SIX DOLLARS & 03 ~~
0~A;:5/05 R:C5:~( ::~;~6 03 CHEeR
,~ ~~
...........-------_._._~_._----_....
FiEF r~u
PENDING!
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,
.
,;:- . Or< ~ e
RECEIPT No 35 E; 2 5
RECEIVED
****TEN THOUSAND THIRTY EIGHT DOLLARS & 41 CENTS
RECEIVED FROM
EVERGREEN STATE BUILDERS
3815 100TH ST SW #2A
LAKEWOOD, WA 98499
BLD-05-0054-YL
SITE: 15779 104TH AVE SE
DATE
REC NO
,A,MOUi'lT
REF I'J()
02/15/05 35625
10,038.41 CHECK
PENDING
MISCELLANEOUS RECEIPT
DIJI.NA
BLDPRMTl149.15, PLNREV485 51, MECHPRMT78 75, PLMBPRMT111, S/INSP145, W/ERU1500
W/MTR300, lilDEP40, TRAFF757 50, S/DEP50, STFEE4 50, S/ERU5417
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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
# 5751 09 02/16/05
Reg #1 SalesPerson SUSAN
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJECTS
1 @ 1, 711 00 1 ,711 00
CK #9265 YELM TERRA LOT #44
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJECT~'
1 @ 1,711 00 /1,71100
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
5,133 00
Total Due
Check
5, 133 00
5, 133 00
----------
----------
Thank YOU
PLEASE KEEP THIS RECEIPT!' J
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLlCA nONl'fORM /i ,
Project Address: ~~~CJ'/~r"AP'&~ Parcel#' 9L;r7f'~O()Q 4500 ~ ',,- :-,,~
Subdivision: Ye {hit i-R-r r;fL lot #" 'f.s Zoning; SvUlg Ii' -fC/lh1'/ j ttr ./ ~ J ",-\'V
hew Construdion U Re-Modell Re-Roof I Addition U Home Occupation Sign &J.~
U Plumbing U Mechanical U Mobile I Manufactu~ Home Placement ~ Other IN'
Project DesaiTscope of Worl<:~ it -F a#I., (:} Re &,duJ,cz.. ( t IV
Project Value: d~() __ 5t. 500 CJ'
::;....-- I
Building Area (sq. ft) 1st Floor / ~ 7/ 2nd Floor //~O Garage 7' J'~ Deck f\5'
Basement Carport Patio Z/ ~ ~
# Bedrooms..1.- # BathroomsZ.S' 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.
BUILDING OWNER NAME.
ADDRESS
CITY
~
~\)
~~
'\ \)
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ARCH ITECTIENGI NEER
ADDRESS iJ2 ~
CITY72lCIJYtJt? STATE tA..// ZIP CjX~2
ICENSE #
EMAlL
TELEPHONE
GENERAL CONTRACTOR \.~ a..s ffU?t..tr TELEPHONE
ADDRESS EMAlL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # t:1./ EXP OAT - ~ CITY LICENSE #
TELEPHONE
EMAIL
V9:< FAX 2<,<:'s:%-9?~
EXP DATE CITY LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
PLUMBING CONTRACJOR-l
ADDRESS ~;: -~
..-.--..
CITY fa STATEU,
CONTRACTOR'S LICENSE #
MECHANICAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
ZIP
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby certify that the above Information is comICt and that the construction on, and the occupancy and the use of the
above described property will be In accordance whh the laws, rules and regulations of the State of Washington and the
City of Velm.
/~~ :z-;/~-~&--
Applicant's Signatu~ ~ Date
Owner I Contractor Owner's Agen 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
';/?-p1tr ---
105 Yelm Avenue WeBt
PO Box 47!J
Yelm. WA 98597
-2.
(360) 458--3B35
(360) 458-3144 FAX
www.ci.yelm.wo.Wl
02/10/2005 17 08
2532?<1,'3183
l)
CASCADE RES I )T";r I AL
'0
PAGE 02
! LOT 4~
EVERqREEN STATE BUILDERS
, 'YELM TERRA <
15802 I04th AVENUE SOUTHEAST
YELM, WA
SITE PLAN APPROVAL
m'llOVCD AS P/lt5(NTID ROOt .~ ~CluaJjlr
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Tf'IS DRAWING IS 3ASEC ON CLIENT-PROVIDED INFOR"^TlDN R(t~tlt"'TED TD g( ACCURATE
ANO RElIA8~r. ANY O!SCR[PA>lCIE~ ~[1WrCN T"'~ DRAWING '.0 THC ,eTUAL ~JTE co,~OlrION~
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