20050041
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Cli'f Of 'fE\...tJI _ 6UI\...OltlG OEP ARitJIEtli
RESIOEtliIA\... CERilflCA iE Of ocCUP AtlC'f
Bu\\ding permit Number
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Building p..ddress
Owner Name
Owner p..ddress
Plan Number
RemarKs
- ----
P-..\\ Code ReQuired
Jul\J 2B 2005
p..reas \ns~ected
s~ecia\ conditiOns
None
o ate
Building OHicial'
. . Inle'n3tion31 Residenli31 Code (CMpler
1hiS slfucture is in compl13nce ;.t ~~: ton st31e Building Code council pursu3nt
5'\-5'\ \NA.C) as ado~ted b\}t 2"7ea dS70 ~2 RCW eftective July \, 200A
to c"a~ters '\ 9. an '
G. carlson
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TO: j;~
FROM YEU'1 SEWER DEPT
FAX#.
FAX NO. 350-458-E:155
Jul 22 2005 03 28PM Pi
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FAX TRANSMISSION'
CITY OF YELM
P.O. BOX 479 - 931 NP ROAD NE
YELM, W A 98597
360-458-8411
FAX 360-458-8166
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DATE: 7 ~ ;2;). - o":}
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From Rf1AJDY
Subject: to IIJAt--S! ~ EL-vY'\ (~R/1
COMMENTS J-.. 0 T 7::Z)) 5"' 71J, 7
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H If you do not receIve all copIes or any copy IS rot legible, please call (360) 458~8411
as soon a!\ pt)sstble.
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CITY OF YELM INSPECTION LOG
PROJECT
Y I Lv--f '7:2
WALL
o 6"
d 8"
o other
/{:;
Date
PERMIT NUMBER ;:)r~ CJ ~Cf /
ADDRESS /b"'7/,7 /tJt! t::f... Av-c S~
SET BACKS Date
Front
Rear
Slde'Flaru..mg
SIde
FOOTING
Q 12"
)a'16"
o other
o required vents
Comments
[J Other
j PVA
FINAL
;ft Sewer Final Ji. Electncal 0 CivIl Final 0 Landscape Fmal 0 C of 0
9!f Address ? 'nsulauon 0 SIte Drainage ?,dewalk
CommentsJb.A ip7 \0\2 Ctl'\ ~ #
2-D
3lf-
8
8
FOOTING REBAR
Date
WALL REBAR
C01\IBIl\ED FRAME/ EXTERIOR SHEAR WALL INSPECTION
Hold downs CJ Shear NaIling 0
Frame ~ Gas/Propane I:- "Pi;)
Plumbing ~ hf}..5f&P,r' Mechamcal [
Comments
I"ISl'LA TION A Gas
~ Foam and Seal
Comments ~~\ ~
[] Electnc
[J V upor burner
SHEET ROCK/SHEAR \" -\LL NAIL
Comments ~, ~J J~ I~
- I I
OTHER Comments
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0041-YL
Issue Date 02/15/2005
(Work must be started within 180 days)
Receipt No
35601
Appl i<rCl.llt:
Name. Evergreen State Builders
Phone:
253-475-6622
Address, POBox 39753
City' Lakewood
State, WA Zip 98499
Property, InformatiOn
Site Address 15767 104th Ave SE
Assessor Parcel No 85840007200
Subdivision Yelm Terra
Lot: 72
Cohtractor'lfiformatioh
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
proj~ctlnformatiq.1J
Project: Yelm Terra
Description of Work: Plan 2200 /2A Lot 72
Sq. Ft. per floor' (1 st) 1172 (2nd) 1022 (3rd) 0 Garage 480 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 1,301 19 993,75 307 44 5 6000 54 9000 $1,000
Building Plan Review 549 75 000 000 o 0000 o 0000
Mechanical Permit 8475 000 000 o 0000 o 0000
Plumbing Permit 11800 2000 9800 7 0000 14 0000 Fixture
Sewer Inspection 14500 000 145 00 145 0000 1 0000 ERU
Water ERU 1 500 00 000 1 500 00 1 500 0000 1 0000 ERU
Water Meter (SFD) 300 00 300 00 000 o 0000 o 0000
Water Deposit 4000 4000 0,00 o 0000 o 0000
Traffic Facilities Charge 757 50 000 757 50 750 0000 10100 Peak PM Trip
Sewer Deposit 5000 5000 000 o 0000 o 0000
State Building Fee 450 4,50 000 o 0000 o 0000
Sewer ERU 5,41700 000 5,417 00 5,417 0000 10000 ERU
TOTAL FEES $10,267,69
Applicant's Affild;lVit:
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor, I futher certify that I am currently
registered in the State of Washington,
OFFICIAL;USE ONLY
# Sets of Prints:
Signatur~ ~
Firm .rS.<$
Date %-/f=-s-
~~tti~~\~~l)~tm~f' .
i ~y,C'~~~~CrrY OF
I !~Y' '~-?~I _
I BJ/-;>-,~. YELM
i ~/ PO 80):479
: /../: ,~ (21m WA ~8597
I . .YE,~.~."," 360,458,8403
. ... .. ~ lJ;.
..' ".{r
RECEIPT No 3 5 60 1
RECEIVED
****TEN THOUSAND TWO HUNDRED SIXTY SEVEN DOLLARS & NTS
REr;EIVEO FROiv1
DATE
REe NO
/A~QUNT
REF NO
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD, WA 98499
BLD-05-0041-YL
SITE 15767 104TH AVE SE
./-'
02/14/05 35601 /' 10,267
I
HISCELLANEOUS ~i>T----
DIANA
PENDING
BLDPRMT1301.19, PLNREV549 75, MECHPRMT84 75, PLMBPRMT118, S/INSP145,W/ERU1500
W/MTR300, W/DEP40, TRAFF757 50, S/DEP50, STFEE4 50, S/ERU5417,
. .. II;'
~. -,.~. .:~ .~!~-
RECEIPTNo 35602
F-"lECEIVED
****TEN THOUSAND TWO HUNDRED FORTY DOLLARS & 96 CENTS
RECEI\/ED FROM
DATE
REG NO
AMOUNT
REF NO
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD, WA 98499
BLD-05-0042-YL
SITE: 15770 YELM TERRA WY SE
02/14/05 35602
10,240 96 CHECK
PENDING
MISCELLANEOUS RECEIPT
DIANA
BLDPRMT1276.77, PLNREV539 44, MECHPRMT78 75, PLMPRMT132, S/INSP145, W/ERU1500
W/MTR300, W/DEP40, TRAFF757 50, S/DEP50, STFEE4 50, S/ERU5417,
-- u. =~ . -~ +",-",--.- '"' -i:!.""'''''';;;
. .... D;'
. _"._.m __ _< .._._. ...__ .__ ___ _
- .
RECEIPT No 35603
RECEIVED
****TEN THOUSAND TWO HUNDRED SIXTY SIX DOLLARS & 03 CENTS
RECEIVED FROM
DATE
REC NO
AMOUNT
REF f\JO
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD, WA 98599
BLD-05-0040-YL
SITE:15780 104TH AVE SE
02/14/05 35603
10,266.03 CHECK
PENDING
MISCELLANEOUS RECEIPT
DIANA
BLDPRMT1299.32, PLNREV548.96, MECHPRMT78 75, PLMBPRMT125, S/INSP145, W/ERU1500
W/MTR300, W/DEP40, TRAFF757.50, S/DEP50, STFEE4 50, S/ERU5417,
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Yelm School District
ATTN: SUSAN CROY
PO BOX 476
YEL~l, ~~A 98597
360-458-1900
Sold to. 16755
EVERGREEN STATE BUILDERS LLC
56622
BUILDERS LLC EVERGREEN STATE
5516 75TH ST W #1
LAKEWOOD, WA 98499
# 5747 10 02/15/05
Reg #1 SalesPerson SUSAN
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJECTS
1 @ 5,13300 5,133.00
~#9252 FOR YELM TERRA DEVELOPMENT LOT
43 7 ,90
----------
SubTotal 5,133 00
Total Due
Check
5, 133 00
5, 133 00
Thank you
PLEASE KEEP THIS RECEIPT'"
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CITY OF YELM
RESlDENTIAL BUILDING PERMIT APPUCA TION FORM
Project Address ~7h 7/~~""1,.v'6' 5d- Parcel #.
Subdivision. '\~\~~-T~("f--i\ Lotit. 7~ Zoning; ~\I\~\ ~IM
i1"New Construction .0 Re-Model J Re-Roof J Addition 0 Home Occupation Sign
o Plumbing IJ Mechanical 0 Mobile / Manufactured Home Placement 0 Other
Project DescriptionJScope of WOO<.: ~ 'f'- ~ \ ~f\~ \t ~ \ d 't-v\.-\- (iH
prOjectva,uflz Z? ~6"
Building Area (sq. ft) 1st Floor #7.2.. z-t Floor/4 ~ Garage f"go Deck
Basement Carport Patio
# Bedrooms '4+-04/11 # Bathrooms Z W Heati,~::~~:)THER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental/;heckJist must accompany permit application.
BUilDING OWNER NAMI:: ~\\ ~tee'\ '0;.-\ -";Te. t{u\ \.d tf"S t.. .1.. "
ADDRESS'"3-8I.5 joot,s.r s..i..J; ~{')t1'e2A EMAll I
CITY L.f\'tte.woo1l) ~TATE W h- ZIP~ 8't'1~ TELEPHONE ZS?>-'-t7S- 66z2.
LICENSE #
MAIL :;l...S,3- 2..8Lf- ~fl0
LEPHONE <~~ €t'~ Ne:knn.l
GENERALCQNtfRACT0R '.$.~e.. ~~ O~\I\e.t" TELEPHONE
ADDRESS EMAIL
CITY . STATE ZIP FAX
CONTRACTOr~S LICENSE # '\J~~b ~BOft:>EXP DA TE~ITY LICENSE #
kJt TELEPHONE ~"3- :531- ';Itt)
EMAIL
ZIP'7FrfY 5"' FAX 252>---536- 9 'b'
EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
ZIP
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
Cop~t of mitigation agreement with Yelm Community Schools, if applicable.
J hereby certify that the above Information Is correct and t~ the construction on, and the'occupancy and the use of the
above described'DWDertv wiD be in accordance with the laws, rules and regulations of the State of Washington and the
City of YelJT1.
N/7~~ ___ 2-~-~o-
Applica~ !~ignaturo < ; Date
Owner f Contractor ~s Ag~Contractor's Agent (Please circle one.)
All permits <ire 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
(3GO) 458-3835
(360) 458-3144 FAX
Ulww.ci,yelm.wa.us
105 Yelm AUei'lue West
PO Boo: 479
YeJm, WA 98.i97
02/07/2005 13 56
2532843183
CASCADE RESIDENTIAL
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PAGE 02
LOT l2
REEN STATE BUILDERS
YELM TERRA
15767 104th AVENUE SOUTHEAST
YELM. WA
STORM LINEjJ - - - - i -- - ~R~~'- ':;G-;'~ n - -- -- - ..,
, 'v-v
WATER LINE --r-""--"---'--"-~- 1I01rS,
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J---p4t~tVE. SE !
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@ 2004 CASCADE ~ESIDENTIAL DESIGN. INC
THIS DRAWING IS llASr.o ON CU~NT-PROVID(D INFll~)l6TIDN llEfRERtNTtl) ~ 8E .CCUI!AT~
ANO RCUA9LE, NiY DI~CR(PA"CI~ !It:TwtEH T~1S OAAwrHc A 0 THE ACTU"~ Sm: CONDIYwNS
Aqr. fII( SDLE Or.SPONSI8ILfTY or THt ClI[HT.
Received
FEB 0 '1 2005
~TE PLAN APPROVAL
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