20040203
CIT'l Of 'lELNI- BUILDING DEPA.RTNlENT
RESIDENTIA.L CERTlfICA. 1E Of ocCUP A.NC'l
Remar\<.s
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~~753
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6Ui\din9 p-ddress
owner Name
Owner f:l.ddress
6ui\din9 permit Number
plan Number
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f:l.reas \nspected
specia\ conditions
None
Date.
6ui\din9 O"icia\
. . 10tefoatioOal Resldeotial Code (Chaptef
1hiS stfUclufe is io COlOpl\aoce ~\t~~~: toO state Buildi09 Code couocil pursuant
5'\-5'\ \Np-C) as adopted bY tn7ea d 70 ~2 RCIN effeclive Jul~ ;,2004
to cnapters '\9.2 an .
G. car\Son
_.-=ta\riii1mm~
FROM YELM SEWER DEPT
FAX NO. 360-458-El166
Jul 05 2005 12 22PM 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- ..;'-05
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FAX#:
PAGES: 1, including this
Cover sheet
From: RA.uQ'i
Subject: HoJ.'SG FI~ALS / '1'~Lw) Thttt.A-
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** If you do not receive all copies or any copy IS not legIble, please call (360) 458-841 I
as soon as possIble.
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CITY OF YELM INSPECTION LOG
PROJECT
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'-k L.~ /.6,44-
,
PERMIT NUMBER
blI-- oZ-e 3
/S?BS /~ V d ~ S<E
ADDRESS
SET BACKS Date
Front
Rear
SIde/Flanking
SIde
FOOTING
2-0
ybJ
~
o 12"
.l'J 16"
/0
WALL
o 6"
~ 8"
other 0 other
o reqUIred vents 50&
FOOTING REBAR
Date
WALL REBAR
Date
Comments
COMBINED FRAME/ EXTERIOR SHEAR WALL INSPECTION
Hold downs 0 Shear Nailing 0 .
Frame 0 Gas/Propane rj ~ -</1
C Plumbmg J~ (ji{ Mechamcal 0
Comments
INSULA TION
o Gas
o Foam and Seal
o Electnc
o Vapor barner
o Other
o PYA
Comments
SHEET ROCK/SHEAR WALL NAIL
Comments
OTHER
Comments
FINAL
rJ Sewer Fmal
~ Address
.t: Electncal
l InsulatIOn
o CIvIl Fmal 0 Landscape Final 0 C of 0
o SIte Dramage 0 Sidewalk
Comments \cc\1 1\~ q ~I\~ ( /..1 Dr l r'; ~ ~ ..)...../
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City of Yelm
Community Development Department
Building Division
Phone (360) 458-8407
Fax. (360) 458-3144
Permit No
BLD-04-0203-YL
Issue Date 01/11/2005
(Work must be started within 180 days)
Receipt No
34503
Applicant:
Name Evergreen State Builders
Phone.
253-475-6622
Address POBox 39753
City' Lakewood
State: WA Zip 98499
Property Information
Site Address 15785 104th Ave SE
Assessor Parcel No 85840006900
Subdivision. Yelm Terra
Lot: 69
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 2502 S/2, Lot 69
Sq. Ft. per floor' (1 st) 1034 (2nd) 1467 (3rd) 0 Garage 461 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 ,408 90 993 75 41515 5 6000 74 1340 $1,000
Building Plan Review 91578 000 000 o 0000 o 0000
Mechanical Permit 7875 000 000 o 0000 o 0000
Plumbing Permit 132.00 2000 112.00 7 0000 16 0000 Fixture
Sewer ERU 5,269 00 000 5,269 00 5,269 0000 1 0000 ERU
Sewer Inspection 14500 000 14500 145 0000 1 0000 ERU
Water ERU 1,500 00 000 1,500 00 1,500 0000 10000 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 5000 000 o 0000 o 0000
State Building Fee 450 450 000 o 0000 o 0000
TOTAL FEES $10,60143
Applicant's Affadavit:
OFFICIAL USE ONLY
# Sets of Prints.
1-II-fJS
L --I.. i..
Date:
By'
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Velru 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 5T W #1
LAKEWOOD, WA 98499
# 5659 13 01/11/05
Reg #1 SalesPerson SUSAN
Item # 2900/MITIGATION
MITIGATION OR TVF
1 @ 1, 711 . 00 1 ) 711 00
CK #9130 FOR YELM TERRA LOT 62
'--...
SubTotal
3,422 00
Total Due
Check
3,422 00
3,422 00
----------
----------
Thank you
PLEASE KEEP THIS RECEIPTI I I
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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
Project I",formation
Project: Yelm Terra
Description of Work: Plan 2502 S/2, Lot 69
Site Address. 15785104th Ave SE
Fees
Item Acct Code
Building Permit 100-500k 032001-322-10-00
Building Plan Review 100001-345-83-00
Mechanical Permit 032001-322-10-00
Plumbing Permit 032001-322-10-00
Sewer ERU 802 412-343-50-01
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 420 120-344-85-00
Sewer Deposit 742402-389-01-00
State Building Fee 160001-386-00-00
TOTAL FEES
Permit No BLD-04-0203-YL
Phone
253-475-6622
City' Lakewood
State. WA Zip 98499
Assessor Parcel No 85840006900
Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
-------------
1 ,408 90 993.75 41515 5 6000 74 1340 $1,000
91578 000 000 o 0000 o 0000
78.75 000 000 o 0000 o 0000
132.00 2000 112.00 7 0000 16 0000 Fixture
5,269 00 000 5,269 00 5,269 0000 1 0000 ERU
145 00 0.00 145 00 145 0000 1 0000 ERU
1,500 00 0.00 1,500.00 1,500 0000 1 0000 ERU
300 00 300 00 000 o 0000 o 0000
4000 4000 000 o 0000 o 0000
757 50 000 757 50 750.0000 1 0100 Peak PM Trip
5000 5000 0.00 o 0000 o 0000
450 450 000 o 0000 o 0000
$10,601 43
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RECEIPT No 34507
RECJ=iVED
*~**TEN THOUSAND ONE HUNDRED EIGHTEEN DOLLARS & 03 CENTS
RECEI\lED FROM
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD WA 98499
BLD-04-0219-YL
SITE: 15849 104TH AVE SE
DATE
REC NO
.",MOUNT
REF NO
01/11/05 34507
10.118.03 CHECK
PENDING
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
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'-'-'-~+-;."'=.:'- ~--"'.! n_
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I RE,p,Fl'4;PEN THOUSAND
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SIX HUNDRED ONE DOLLARS & 43 CENTS
RECEIVED FROM
DATE
01/11/05
REC NO
34503
AMOUNT
10.601.43 CHECK
REF NO
PENDING
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD WA 98499
BLD-04-0203-YL
SITE: 15785 104TH AVE SE
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
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EVER. :REEN STJi1E BUlLDE:RS
YELM. TER'RA'
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPUCATION FORM
Project Address. L c+ (39 Parcel #.
Subdivision '\ ~\ 11"\ -\-~('t'-I\ lot #. ~q Zoning; <;,,,,,9.)\ 8\1N\
flNew Construction 0 Re-Modell Re-Roof I Addition 0 Home Occupation Sign
o Plumbing 0 Mechanical 0 Mobile I Manufactured Home Placement 0 Other
Project Descriptipn/Scope of Work. S "" <0 \ ~f\,"", \t IOU. \ d~,^---\' ,1\-\
Project Value 1\ L. ~\ ~
Building Area (sq. ft) 1 sl Floor \b'S 'l 2nd Floor lID Garage ~ Deck
Basement ''f. Carpo~~Patio ~ t b
# Bedrooms~ # Bathrooms~ Heating eTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? 1JcJ If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNERNAME ~\\~tee'1 ~-\Jtte ~\\(hr~ L. L. (.
ADDRESS3.815 j{)()'M S.T :>,<.J, ~\.Ht'€.'2..1't EMAIL I
CITY L-f\-K,e.wC\1"v.J STATE uJ ~ ZIP, 8...... ~~ TELEPHONE 2-S'3-t.t.7S- 66 Z 2
GENERALGONTRAcTOR $~€.. IT~ OWII\e> TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # ~\Jer-~\o '180 fbEXP DA TE~ITY LICENSE #
PLUMBING CONTRACTORj~et S:O\JV\ ~ k.1ly- TELEPHONE ~5:,- ~31- '700
ADDRESS IE!iR CfYf'-1 s.::::-\ ~ EMAIL
CITY~ STATE uJ4 zlpcrPJ-{y S FAX 2....'53 -...536- 9 ~bb
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
ZIP
Copy of mitigation agreement with Yelm Community Schools, if applicable
I hereby certify that the above Informaticn Is correct and that the construction on, and the' occupancy and the use of the
above describad pro pert will be in accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
1\--[6 .-o~
pplica ' Signature , Date
Owner I Contractor ~er's Ag~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 West
PO Box 479
}elm, WA 98597
(360) 458-3835
(360) 458-3]4'1 FAX
www.ci.yelm.wa.us
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Evergreen State Builders LLC (License #- EVERGSB980PB)
5700 _100th Street S.W, Suite 630, Box 197, La kewood , WA 98499
253-475-6622 (Fax 253-475-6127)
DESCRIPTION OF MATERIALS for
YELMTERRA
8' ceilings on .firstlloor
Siding: 8" pre-primed James HardIe lap sidmg on front, James Hardie single wan
sidmg sides and back; James Hardie shakes or shake panels as accents
front elevation per plan.
Roofing: Architectural ComposItion roof.
Windows: Vinyl wmdows to code and as per plan.
Driveway: Broom finish.
PatiolWalkways: Broom finish.
Cabinets: Oak cabmets, flush paneL
Doors:
Insulated steel, 0 fiberglass.
Exterior:
Mmwork:
Embossed pack e
I
Stool and Aprollnly
Wblldow Wrap:
Plumbing:
Kitchen Sink: 33x22, 3- ole, double-sink. Stainless with chrome delta faucet.
Lavatory:
. Powder Roo . whIte WIth Delta chrome faucet.
cet Hall Bath,~ K1 gore white sink with Delta chrome faucet.
till Master Bath; (2) 20x 17 white with Delta chrome faucets.
e rub Valve, Master bath. Delta chrome or eqUIvalent.
.. TUb/Shower! alve.. Main bath: Delta tub and shower valve.
. Shower Valv . Master: Delta or eqUIvalent
<Ill Toilets. whitb, per plan.
Batb enclosures:
Hot Water Tank:
Hosebib:
Hardware:
Bath hardware:
Flooring:
Countertops:
Painting:
Appliances:
Wiring:
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Master bath: Clear glass door on separate shower WIth chrome tnm.
Tubs: Fiberglass white.
Gas 50 gallon.
Two per plan.
Locks interior: Chrome
.Locks exterior: Chrome
Towel bars~ Chrome
Paper holders: Chrome
c~ Dining room, livmg room, stairs, bedrooms, closets, 6 lb., 1/2"
rebond pad.
Vinyl: Utility ro()m, haB bath and Entry
Lammate: Whoh~ house
Exterior Trim: 'VIlhite or color from approved hst.
Exterior Body: Flat solid body pamt from approved list.
Front Door~ Enamel, white or accent color from approved list.
Intenor Walls: Drywall sealer coat, then one coat flat latex.
Kitchen and batl~t9oms: Low sheen enamel.
Range/Oven. Whirlpool wlute.
Dishwasher: Whirlpool Self Clean,Whlte.
DISpOSal: 1/2 HP
Icemak~ Refrigerator space plumbed for icemaker.
Microwave. \Vhirlpool whIte
Phone (2) cabl!;: (2)
Page two of two