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6Ui\din9 ~ddress
owner Name
owner ~ddress
p\an Number
6ui\din9 permit Number
Areas \nsgected
Sgecia\ conditions
f>,.\\ Code Reauired
ju\\I 22 2005
RemarKS:
-----
None
oate
6ui\din9 O<<iciat
. . . 1M Inle",allonal Residenllal Code \ChaP'"
1hls sl.ucIU.e Is ,n co",pllance;;t. I n 51ale Building Code counc,' pUlSUanl
5~-5~ W~c) as ado9\ed b'/\ 2"'1e ~,;,~ni20RC\N ellecl"- JulV 1.200<1
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CITY OF YELM INSPECTION LOG
PROJECT \./1 I.v-I -7'.3
PERMIT NUMBER 0 1r- CJO L/ ~
ADDRESS IS78 t9 I () Y tt 4ve 5 ~
SET BACKS Date
Front -2 tJ
-
Rear jf~
Side/flanking /0
Side /t)
FOOTING
o 12"
ff16 "
o other
o reqUired vents
WALL
o 6"
.A:J8"
o other
,/7'
Vir
J -<i-oS'
$/
FOOTING REBAR ~ Date 3-11- 0 S' \V ALL REBAR cRJi Date ~-I <.- 0 b-
Comments
COMBINED FRAME/ EXTERIOR SHEAR WALL INSPECTION
Hold downs 0 Shear Nailing 0
Frame 0 Gas/Propane 0
Plumbing 0 Mechanical 0
Comments
INStTLA TION
o Gas
o Foam and Seal
o Electnc
o Vapor barner
Comments
o Other
o PYA
SHEET ROCK/SHEAR \V ALL NAIL
Comments
OTHER
Comments
F91AL I'
ft... Sewer Final ~~:~~al. 0 Civil Final 0
;r Address D~ 0 Site D~ 0
Comments Wz-V hU.L- ~cJ~
Landscape Final
Sldewalk,Afl k
o C of 0
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TO:~
FROM YELM SEWER DEPT
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FAX#:
FRX NO. 360-458-EI166
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Jul 22 2005 03 28PM Pi
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FAX TRANSMISSION'
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CITY OF YELM
P.O. BOX 479 ~ 931 NP ROAD NE
YELM, W A 98597
360-458..8411
FAX 360w458-8166
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DATE: 7- ;2;).- D~
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PAGES: I , including thIS
Cover sheet
From' RfWD'T
: 1
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Subject: r I/lJAL..5/ 'i €:l-"'" (~IV}
COMMENTS- J-oT 7") )~7/'7 '7"LJ ?: ~L;"lJO 6
..,.(,. '"' u 104 f.E f1u~. s € , 6 r-..J, p( , \ ,l
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L6T 43 /5 79"'D 10 1Jj. < 65- 5if 3D .0;
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*'" If you do not receIve all copies or any copy is not legible, please call (360) 458-8411
as soon as possIble.
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0040- YL
Issue Date 02/15/2005
(Work must be started within 180 days)
Receipt No
35603
App.lic;ant:
Name Evergreen State Builders
Phone:
253-475-6622
Address: POBox 39753
City' Lakewood
State. WA Zip 98499
Property lr"lfo.trri~ti()r"1
Site Address. 15780 104th Ave SE
Assessor Parcel No 85840004300
Subdivision. Yelm Terra
Lot: 43
Contractor Information
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 2211/2, Lot 43
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 1,299 32 993 75 305 57 5 6000 54 5660 $1,000
Building Plan Review 548 96 000 000 o 0000 o 0000
Mechanical Permit 7875 000 000 o 0000 o 0000
Plumbing Permit 125 00 20.00 105 00 7 0000 15 0000 Fixture
Sewer Inspection 14500 000 14500 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 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 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 $10,266.03
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.
Signature~~ ~ Date r~I!1S-
Firm ""5 ~
OFFICIAL USE ONLY
#'Sets of Prints.
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD. WA 98499
BLD-05-0041-YL
SITE 15767 104TH AVE SE
02/14/05
35601
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PENDINGI
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RECEIPT No 35601
RECEIVED
****TEN THOUSAND TWO HUNDRED SIXTY SEVEN DOLLARS & 69 CENTS
RECEIVED FROivl
DATE
REC NO
AMOUNT
REF NO
10,267.69 CHECK
MISCELLANEOUS RECEIPT
DIANA
BLDPRMT1301.19, PLNREV549 75, MECHPRMT84.75, PLMBPRMT118, S/INSPI45,W/ERUI500
W/MTR300, W/DEP40, TRAFF757 50, S/DEP50, STFEE4 50, S/ERU5417,
o ,}
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.. ~. ~.- .. .,....,.., .,,-.....-
RECEIPT No 35602
RECEIVED
****TEN THOUSAND TWO HUNDRED FORTY DOLLARS & 96 CENTS
RECEIVED FROM
D.A.TE
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!
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MISCELLANEOUS RECEIPT
DIANA
BLDPRMT1276 77, PLNREV539 44, HECHPRMT78 75, PLMPRMT132, S/INSPI45, W/ERUI500
W/MTP300, W/DEP40, TRAFF757 50, S/DEP50, STFEE4 50, S/ERU5417,
- 0 "~A~-~ ~~:- =_
RECEIPT No 35603
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD, WA 98599
BLD-05-0040-YL
SITE 15780 104TH AVE SE
-=-=:----
CEN;s------.-.---~
AMOUNT ') RE
RECEIVED
* * * *TEN THOUSAND T~W HUNDRED SIXTY SIX ~A-R'S-~03
RECEIVED FROM REG. NO
35603
10,266 03 CHECK
MI S :;1Jj
DIANA
BLDPRHT1299 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
YELM, \~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
BK #9252 FOR YELM TERRA DEVELOPMENT LOT
43,72,90
----------
SubTotal 5,13300
Total Due
Check
5 I 133 00
5, 133 .00
----------
----------
Thank you
PLEASE KEEP THIS RECEIPT I I I
CITY Of VELM
RESIDENTIAL BUILDING PERMIT APPUCAT'o,", FORM
Project Address:/57"A~ /~.y ~V& ~ Parcel #- lJ
Subdivision: Yefwt. !:er("'Vl Lot#. ~.3' Zoning; ~g l.e ~./Ih1II'j
hew Construction 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~SCOpe of Work:~ ~,~ -Fatfll 0 R.t. &tduJ-, CL (
Project Value: .z 2 r- ~~
Building Area (sq. ft) 1st Floor/.67/ 2nd Floor //~O Garage '7'/7' Deck
p ,
Basement Carport Patio Z/ h
# Bedrooms:J # Bathrooms-Z..r Heatin~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.
ARCHITECTIENGINEER
ADDRESS iJ L ...QJ .
CIlY72lClJrfla
ICENSE #
EMAlL
ZIP 9~;@z TELEPHONE
BUILDING OWNER NAME: E
ADDRESS
CllY
GENERAlCONTRACTOR \~a.s ~ TELEPHONE
ADDRESS EMAlL
CllY STATE FAX
CONTRACTOR'S LICENSE # e~ EXP DAT . tji CITY LICENSE #
PLUMBING CONT~~aVf' <.-.. IAA -- ATELEPHONE~J537 1:?o/'CJ C)
ADDRES~8'/~- P EMAlL
CITY721 n1. STATEUhl zIP'.18Y!I,\ FAX Z~.";;;"..s:%-qc;;,.~
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
ZIP
TELEPHONE
EMAIL
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 cerOfy that the above Information is cOfTeCt and that the construction on. and the occupancy and the use of the
above described property will be In accordance with the laws, rules and regulations of the State of Washington and the
City ofYelm.
~___ 2~-~-
'J.pplicant s Signature - Date
Owner I Contractor~ner'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 WeBt
PO Bo% 419
Yelm, WA 98591
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm_wo.1.UI
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LOT 43
EVERdREEN STATE BUILDERS
-\ YELM TERRA
15780104thAVENUESOUTHEAST
YELM, WA
SITE PLAN APPROVAL
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ME m~ SOU: ~1T or ,HI: CUENr.
FEB 0 7 2005