20050054
Cli'( Of '(ELM _ 6UI\..OIl-lG OEP ARiMENi
RESIOENiIA\.. CERilflCA iE Of oCCUP ANC'(
r@j\.W.J~'
Building p..ddfess
'\5779 '\04\" p.,\Ie. SE.
~s~
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owner Natne
owner j\ddress
Plan Nufl"\ber
Building peffl"\it Nufl"\oef
j\feas \nspected
special conditions.
NI Code ReC1uired
~
Retnaf\<'s.
-----
None
Date
Building Omcial
. . e 10lero.tiOo.1 Resideoti.1 Code \C~.?Ier
l~iS slruclure is io com?lIaoce :;t:~~o 100 SIale 6uilo,09 Code couocil ?UfSU.ol
5'\-5'\ \fJp..C) as adopted 0'1 t,,;a d 10 ~2 RON e<<ec"ve Jul1 j. 2004
to c"aptefS '\ 9 21 an '
G. caflson
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CITY OF YELM INSPECTION LOG
PROJECT
'71 ~o-:t 70
ADDRESS J 0779
104 ~ s.E.
WALL
o 6"
6 8"
o other
Date
Comments
o Other
fJ PVA
Comments
COMBINED FRAME~XTERIOR SHEAR WALL INSPE90N
Hold downs A" 0J;f}.. '~ Shear Nalll~ .U/.A- % f)JY
Frame 0' 1!uS GaslPropane Lr NA '7/1tjJ
PlumbIng /Q]I ciA.- ....,1tq/p< Mechamcal /0 I
I ~J
Comments JIv 1~ .
I~Sl LA TION jf Gas
~' Foam and Seal
Comments iYJJV-..-/ lh~JK'
- /
SHEET ROCK/SHEAR \VALL NAIL
commcnts~~(
OTHER
o Landst;'e Fma~,e coV
o S]~~\~i3 .
PERMIT NUMBER 0 S" - 00 S <./ - y,-
SET BACKS Date
Front 20
Rear 40
SIde 'FlankIng
SIde
FOOTfNG
o 12"
"tiJ 1 6"
o other
o requIred \'ents
S;.r
I
FOOTING REBAR
Date
WALL REBAR
o Electnc
rt Vapor barner
l'AL
Sewer Final
Address
hlcctncal
.D Insulatlo
1\'11 FInal
SIte DraInage
Comments
FROM YELM SEWER DEPT
Sep 23 2005 09 58AM Pi
FAX NO. 360-458-El166
FAX TRA.NS'MISSION
CITY OF YEL1\ll
P.O. BOX 479 - 931 NP ROAD NE
YELM, W A 9gS97
360~458-8411
FAX 360-458-8166
~~~ '.
TO" ~~fiAJ
DATE' "...~'3-~,-
FAX# .
PAGES: J , including this
Cover sheet
From: ~AIUO l(
Subject P.t~At-1 Y~lJ"C"'\ l'E1tl2.A
60- CS-IOO I GU
COMMENTS: l-.oT (70) JJS'7?q 1()41:H AvE"". 'S' b,
** If YOll do not reCclve all copIes or any copy IS not legible, please call (360) 458~8411
llS soon us pmislble
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0054- YL
Issue Date. 02/16/2005
(Work must be started within 180 days)
Receipt No
35625
Applicant:
Name. Evergreen State Builders
Phone.
253.475.6622
Address 3815 100th St. SW, Ste 2A
City' Lakewood
State WA Zip 98499
Pro pertyJnform ation.
Site Address: 15779 104th Ave SE
Assessor Parcel No 85840007000
Subdivision Yelm Terra
Lot: 70
Contractorlnfo'rm a!ion
Name Evergreen State Builders
Contact: McCullem, Tom
Phone. 253-475-6622
Address. POBox 197
City' Lakewood
State: WA Zip'
Contractor License No EVERGSB980PB
Expires: 10/02/06275
Business License.
Proj~ENrlf()rmation.
Project: Yelm Terra
Description of Work: Plan 17 40B/3, Lot 70
Sq. Ft. per floor' (1st) 854 (2nd) 952 (3rd) 0 Garage 418 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 ,149 15 993.75 155 40 5 6000 27 7500 $1,000
Building Plan Review 48551 000 000 o 0000 o 0000
Mechanical Permit 7875 0.00 000 o 0000 o 0000
Plumbing Permit 111 00 2000 91 00 7 0000 13 0000 Fixture
Sewer Inspection 145 00 000 145 00 145 0000 1 0000 ERU
Water ERU 1 500 00 0.00 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 10100 Peak PM Trip
Sewer Deposit 5000 50.00 000 o 0000 o 0000
State Building Fee 450 450 000 o 0000 o 0000
Sewer ERU 5,41700 000 5 417 00 5,417 0000 1 0000 ERU
TOTAL FEES $10,038.41
Appl i cant's' Affadavit:
QF;F;ICIALUSE 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 /pt Date Z-/~ -~
Firm r.s-~
'., # Sets ,of Prints.
,F.i"..a.....I'....(.n.~,.p...e CO"". ..... ..
Date.
By: '.
Applicant:
o
o
q'\f\
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
~\) 6
'<( \b 1)C:::S ... ~ Permit No BLD-05-0054-YL
\. ~v~'
y'<v<:O ~ ~
00 0 ')&) /P d- c;-
Name. Evergreen State Builders
Address: 3815 100th St. SW, Ste 2A
Project Information
Project: Yelm Terra
Description of Work: Plan 1740B/3, Lot 70
Site Address. 15779 104th Ave SE
Fees
Item
Building Permit 100-500k 032001-322-10-00
Acct Code
Building Plan Review 100 001-345-83-00
Plumbing Permit
Mechanical Permit 032 001-322-10-00
032 001-322-10-00
Sewer Inspection
Water ERU 712 401-343-80-01
805 412-343-80-00
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
City' Lakewood
Permit Fees Schedule
Phone
State. WA Zip 98499
253.475.6622
Assessor Parcel No 85840007000
Item Fee Base Amt
1,14915 993 75
48551 000
7875 000
111 00 2000
145 00 000
1,500 00 000
300 00 300 00
4000 4000
757 50 000
5000 5000
450 450
5,41700 000
$10,038.41
155 40
Unit Rate No. Units Unit Desc
Unit Fee
000
56000 277500 $1,000
o 0000 0 0000
9100
7 0000
o 0000 0 0000
000
14500
145 0000
13 0000 Fixture
1 0000 ERU
10000 ERU
o 0000
o 0000
1 0100 Peak PM Trip
o 0000
o 0000
1 0000 ERU
1,50000 1,5000000
000 0.0000
000 o 0000
757 50 7500000
000 o 0000
000 o 0000
5,41700 5,4170000
"-"""";;- -;"]'~
J. -. . D;"
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RECEIPT No. 35 623
I
II' RECEIVED
I ****TEN THOUSAND TWO HUNDRED SIXTY SEVEN DOLLARS & 69 CENTS
I RECEIVED FROM DJlTE REC NO AMOUNT
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REF NO
EVERGREEN STATE BUILDERS
3815 100TH ST SW #2A
LAKEWOOD. WA 98499
BLD-05-0056-YL
SITE: 15786 104TH AVE SE
02/15/05
35623
10.267.69 CHECK
PENDING!
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MISCELLANEOUS RECEIPT
DIANA
BLDPRMT1301.19. PLNREV549.75, MECHPRMT84 75. PLI1BPRMT118, S/INSP145, W/ERU1500
W/MTR300, W/DEP40, TRAFF757 50, S/DEP50, STFEE4 50, S/ERU5417,
. ,," t.:::,
., . I' '-~-
- .-_. ~':';'.
. .
--.,.,
.-. -_.~. ._. .--.-...
RECEIPT No ::: 5624
RECEIVED
****TEN THOUSAND TWO HUNDRED SIXTY SIX DOLLARS & 03 CENTS
F(ECEI\/E[\ FROM
DATE
REC NO
AMOUNT
FiEF t'~O
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
PENDINGl
MISCELLANEOUS RECEIPT
DIANA
BLDPRMT1299 32. PLNREV548 96. MECHPRI1T78 75, PLMBPRMT125, S/INSP145, W/ERU1500
W/MTR300, W/DEP40, TRAFF757 50, W/DEP50, STFEE4 50, S/ERU5417,
~ ;; .~~~~~~~~:~ e ~ =
RECEIPT No '3 5 E) 2 5
THOUSAND THIRTY EIGHT DOLLARS & 41 CENTS
~_____ "'~ i
......- -
/.......
IUSCELLANEOUS RECEIPT ----~
DI.n.NA
RECET'jED FROM
EVERGREEN STATE BUILDERS
3815 100TH ST SW #2A
LAKEWOOD. WA 98499
BLD-05-0054-YL
SITE 15779 104TH AVE SE
BLDPRMT1149 15, PLNREV485 51. MECHFRMT78 75. PLMBPRMTl11, S/INSP145. W/ERU1500
W/MTR300, W/DEP40, TRAFF757 50, S/DEP50, STFEE4 50, S/ERU5417
o
Yelm School District
A TTN SUSAN CROY
PO BOX 476
YELM, ~JA 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 # 2900jMITIGATION
MITIGATION/CAPITAL PROJECTS
1 @ 1, 711. 00 1 , 711. 00
CK #9265 FOR YELM TERRA LOT #45
SubTotal
Total Due
Check
5,133.00
5, 133 00
Thank yoU
PLEASE KEEP THIS RECEIPT! I I
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RESIDENTIAL BUILDING PERMIT APPLICA~ FORM
Project Address: Ar7;. ./.e'"+'~~C' ~ Parcel It ~ j if 1tJn O/OCo
Subdivision: YefM, l.-errA.. Lot#. 70 Zoning; ..&Ut~ Ii! --f{~/J;; .
~ew Construction U Re-Modell Re-Roof I Addition U Home Occupation Sign ./ 1~
U Plumbing U Mechanical u Mobile I Manufactured Home Placement u Other '::'?5
ProjedDesai~~~~;1lt -ram1J~ ~wduJJcd
Project Value: ~~ ?b_ _')..,'1,77-
,."r ,
Building Area (sq. ft) 111 FIoor~ 2nd Floor 'Sz... Garage -11/ ~
Basement Carport Patio 2- / ~
# Bedrooms3- # Bathrooms2.:.. 5" Heati~THER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
Deck
~;jJ7~
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BUILDING OWNER NAME.
ADDRESS
CITY
ZIP '1X}//) Z
GENERAL CONTRACTOR \~ as tJ71fttr TELEPHONE
ADDRESS EMAll
CITY STATE FAX
CONTRACTORS LICENSE # EXP OAT . CITY lICENSE #
TELEPHONE
EMAll
ZIP FAX z(".~~-qc:::;.~
EXP DATE CITY lICENSE #
MECHANiCAl CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S lICENSE #
ZIP
TELEPHONE
EMAlL
FAX
EXP DATE CITY lICENSE #
./'
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I h....by certify that the above 1nf0rRlllt1on is c:0fJ1ICt and that the c:onstruc:tlon on. and the oc:c:upanc;J and ... use of the
above deac:rtbed property wll be In accordanc:e with the "'s, ruIIIS and ~ulatlons of the Stllte of W.tdngton and the
City of Velm.
/~~--- 2-/7"-'&-
Applicant's Signature - Date
Owner I Contractor~. 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 wortt is suspended or abandoned for a periOd of 180 days
?~;J/A-__ ~~~
105 Y.lm A~nu. Waf
PO Boz 418
Y.lm. WA 'S5J1
(36D) 45&-3831
(360) 4511-3144 FAX
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1 LOT 10
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E~~~RE~~~ BUILDERS
157791104thAVENUE SOUTHEAST
I YELM, WA
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mlS D"^WJ~G IS BASEO 0" CUENT-I'RCYlOrO IflFOll\lAnON IlEP~(StIlT(O TO ~[ ACCUIl^-r[
A!';O RUIAB~t. ANY D;SC~EPAHClts 8tTW([H nns llR^WIHC ",,' THt "CTUA~ SlTt COHOITIOh-S
AR( l'Hr SOU: IICS>ONSI9IL1TY or THt Cl/DlT.
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SCALE " : 30'