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CITY OF YELM INSPECTION LOG
PROJECT
~f (pJ-
.
'il
PERMIT NUMBER
6,/-- (:) 2-1 Cj
/s~y9 /t) V lj An SG-
ADDRESS
SET BACKS Date
Front ZJO t
Rear 68
Side/Flankmg /0
Side ~
FOOTIN G
o 12"
.CJ--1b"
o other
o reqUired vents
WALL
o 6"
;;:r8 "
o other
IY
FOOTING REBAR Date W ALL REBAR Date
commen~ v.. F \ \ ~11 rJ{
I
COMBINED FRAME/ EXTERIOR SHEAR WALL INSPECTION
Hold downs 0 Shear Naihng 0
Frame D Gas/Propane' Ii%\ IIv'IM 4;
Plumbmg 0 Mechamcal )l:(
Comments
INSULATION
o Gas
o Foam and Seal
o Other
o PYA
o Electnc
o Vapor barner
Comments
SHEET ROCK/SHEAR WALL NAIL
Cornmeols _ii.lA ~. 5 JIIfl
OTHER Comments
FINAL
/!!.. Sewer Fmal ~., Electncal 0 Civil Fmal
o Address 1 InsulatiOn 0 Site Dramage
Comments r ~d ~~/\'U +-~/X~ (JI-./\./
o Landscape Fmal 0 C of 0
o Sidewalk V';'/tl-~
IN~ d.. ~J7/t1J~
FROM YELM SEWER DEPT
6Af- ~ ()
R~~
~ A TO: (p(lE'T
FAX#:
From: RPt,uo c..r
FAX NO. 360-458-E3166
Jun. 27 2005 12 02PM Pi
FAX TRANSMISSION
CITY OF YELM
P.O. BOX 479 - 931 NP ROAD NE
YELM, W A 98597
360-458-8411
FAX 360~458..8166
DATE: ~~)7-D~~
PAGES' I , including this
Cover sheet
Subject: HOlJi$ E' h~ AL / '-1. '<:l..""" ~l2A
COMMENTS J..-.b T ~a...I' ~ 4 ~ ) l)1.{~ Au ~~ "s. IE'.
os- 5~JO ,00
** If YOll do not receive all caples or any copy IS not legIble, pJea~e call (360) 458-8411
as soon as possIble.
:i
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o
City of Yelm
Community Development Department
Building Division
Phone (360) 458-8407
Fax. (360) 458-3144
Permit No
BLD-04-0219- YL
Issue Date 01/1112005
(Work must be started within 180 days)
Receipt No
34507
Applicant:
Name Evergreen State Builders
Phone.
253-475-6622
Address POBox 39753
City' Lakewood
State WA Zip 98499
Property Information
Site Address. 15849 104th Ave SE
Assessor Parcel No 85840006200
Subdivision. Yelm Terra
Lot: 62
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 62
Sq Ft. per floor' (1st) 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 12500 2000 1 05 00 7 0000 1 5 0000 Fixture
Sewer ERU 5,269 00 000 5,269 00 5,269 0000 1 0000 ERU
Sewer Inspection 14500 000 145 00 145 0000 1 0000 ERU
Water ERU 1,50000 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 50 750 0000 1 0100 Peak PM Trip
Sewer Deposit 5000 5000 000 o 0000 o 0000
State Building Fee 450 450 000 o 0000 o 0000
TOTAL FEES $10,118.03
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 ~ng~_~ ..tL _
Signature ~~/JI~ Date
Firm E~ ~
OFFICIAL USE ONLY
# Sets of Prints.
\-\\-o~
~L.(..c.. .
By'
o
o
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
~ 5659 13 01/11/05
Reg #1 SalesPerson SUSAN
Item # 2900/MITIGATION .~.
MITIGATION OR TVF ,/' ---
1 @ 1,711. 08 1 , 711 00
CK #9130 FOR YELM YERRA LOT 62
Item # 2900/MITIGAT ON
MITIGATION OR TVF
1 @ 1,711 00 1, 711 00
CK #9130 FOR YELM TERRA LOT 69
SubTotal
3,422.00
Total Due
Check
3,422 00
3,422 00
Thank you
PLEASE KEEP THIS RECEIPTI I I
o
o
.~ . . D:'
. e
DO.' . . l
~~_ - -r."~:~ ~',~-
REC 1PTt 3450~
---------
,,-
." -.-., -..-..-..-. ,.....-
RECI=IVED
*~**TEN THOUSAND ONE HUNDRED EIGHTEEN DOLLARS & 03 CENTS
RECEIVED FROM
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD WA 98499
BLD-04-0219-YL
SITE: 15849 104TH AVE SE
DATE
REC NO
AMOUNT
10.118.03 CHECK
REF NO
PENDING
01/11/05 34507
MISCELLANEOUS RECEIPT
DIANA
BLDPRMT1299.32. PLNREV548.96. MECHPRMT78.75. PLMBPRMT125. S/ERU5269. S/INSP145
W/ERU1500. W/MTR300. W/DEP40. TRAFF757.50. S/DEP50. STFEE4.50
RECEIPT No 34 503
REPf,l~~~N THOUSAND SIX HUNDRED ONE DOLLARS & 43 CENTS
I
I
l
'--
RECEIVED FROM
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD WA 98499
BLD-04-0203-YL
SITE: 15785 104TH AVE SE
DATE
REC NO
AMOUNT
10.601. 43 CHECK
REF NO
PENDING
01/11/05 34503
MISCELLANEOUS RECEIPT
DIANA
../
BLDPRMT1408.90. PLNREV915 78. MECHPRMT78.75. PLMBPRMT132. S/ERU5269. S/INSP145
W/ERU1500. W/MTR300. W/DEP40. TRAFF757 50, S/DEP50. STREE4.50
o
o
Permit Fees Schedule
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name Evergreen State Builders
Address POBox 39753
Projectlnf()rmation
Project: Yelm Terra
Description of Work: Plan 2211/2, Lot 62
Site Address 15849 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 032 001-322-10-00
SewerERU 802 412-343-50-01
Sewer Inspection 805 412-343-80-00
Water ERU 712 401-343-80-01
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 160 001-386-00-00
TOTAL FEES
Permit No BLD-04-0219-YL
Phone'
253-475-6622
City' Lakewood
State: WA Zip 98499
Assessor Parcel No 85840006200
Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
-------------
1,299 32 993 75 305 57 5.6000 54 5660 $1,000
548.96 000 000 o 0000 o 0000
78.75 000 000 o 0000 o 0000
125 00 2000 105 00 7 0000 15 0000 Fixture
5,26900 000 5,269 00 5,269 0000 1 0000 ERU
145 00 000 145 00 145 0000 1 0000 ERU
1,50000 000 1,500 00 1,5000000 1 0000 ERU
300 00 300 00 000 0.0000 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 0.0000
450 450 000 0.0000 o 0000
$10,118.03
-8 () . c~/i S/
ProjectAddtess:~ ~/t!J?" At'&- 7E Parcel#"
SubdivisiOn: Yefi-v1 7e,rA- Lot#: 6 Z Zoning; ~~ If! 4Vh11 /j
~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
Project Description/Scope of Work:~ I() 1fJ. -Fah1" 0 f}. &tduJ-, CL r
Project Value: o? .2~, '9SCJ
Building Area (sq. 1\) 1st AoorA~I/ 2nd Floor
Carport
o
Garage "/""/ b
Patio
Deck
Basement
# Bedrooms-1-
# Bathrooms Z,S-
Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
completed environmental checklist must accompany permit application.
If yes, a
BUILDING OWNER NAME.
ADDRESS
CITY
ARCHITECTJENGINEE
ADDRESS .b Z. ...w
cllY7Z1tJm1a
GENERAL CONTRACTOR \~ as trUPUr TElEPHONE
ADDRESS EMAlL
CllY STATE ~P FAX
CONTRACTOR'S LICENSE # -Ef4 EXP DA CllY LICENSE #
PLUMBING ~:r.OR..J
ADDRESS '?ilK ~
CllYJa STATE
CONTRACTORS LICENSE #
TELEPHONE ~
EMAlL
~, FAX 2s-:<:~-q~~
EXP DATE CllY LICENSE #
MECHANICAL CONTRACTOR
ADDRESS
CllY STATE
CONTRACTOR'S LICENSE #
ZIP
TElEPHONE
EMAlL
FAX
EXP DATE CIlY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby certify that the above information is comlCt and that the c:onstruction on, and the occupancy and the use of the
above described pJOperty wW be In accordance with the laws. rules and l1l9u1atlons of the State of Washington and the
City of Yelm.
Applicant's Signature _~=r Date
Owner I Contractor~r'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 YeJm Auenue West
PO Box 479
Yelm, WA 98591
(360) 458-38as
(360) 458-3144 FAX
www.ci.yelnuua.us
12/23/2004 12 26
12/23/2~~4 18'2~
2534756127
2531'(,843183
l)
EVERGREEN 5T BUILDER
CASCADE RE5IfJIAL
PAGE 01
PAGE fn
I LOT b2
EVERdREEN STATE BUill mRS
I YELM TERRA
YELM, WA
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TllJ'!I :)fIAW/Ne IS ~Kll ON C',lfl'l'l-"IIVQ)Ee IHro~"ATION lIE "I:st"",rt1 TO It f.CCURATE
llNll Qrl.1A8l.t, AI4r am:lIlr'AIIClIn ~N TlfIS IMAWI~ " D .PIE" IICTUAL 91T11 CON~ITK:rN5'
ARE TIIr sou: A OIISI!IIL'1"l' llr ~ I "T.
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