20040202
C11>t Of >tELtJ\ _ 6UILOltlG OEP Jl,R1tJ\Etl1
RESIOEtl1,JI,L CER1'f'CJI, 1E Of ocCUP Jl,tlC>t
~
~
~~
~W~53
~
~
eui\din9 Address
owner Name
owner p..ddress
p\an Number
eui\din9 permit Number
Remar\<.s',
---
p...\\ Code ReQuired
~
p..reas \nspected
specia\ conditions
None
Date
eUi\din90<<icia\'
. . I le,oaliOoal Resideotial Code \C\lapleT
1\liS sl,uclure is io compllaoce ;t:e I~n Slale Building Code council pursuanl
5~~5~ WAC) as adopted b,/ to; das"70\n~2 RCW e<<ecti'Je jU\'1 ~. 2004
to coapters ~9,21 an I .
G. car\Son
__~ra\tf@~
~~
G
o
(\
LJ
CITY OF YELM INSPECTION LOG
PROJECT
~l\~
.---
'J~t~ J e ......r~
PERMIT NUMBER f) 4 - (5 Z- D 2-
ADDRESS /532-0 /0 V 'l:/- Avt. 5-E
SET BACKS Date
Front
Rear
SIde/Flankmg
SIde
FOOTING
WALL
FOOTING REBAR
2-0 0 12" 0 6"
31 ;t 16" ~ 8"
Z 0 other 0 other
q . 0 reqUIred vents IS--
~ Dale ~ W ALL REBAR """""-Date +
Comments
COMBINED FRAME/ EXTERIOR SHEAR WALL INSPECTION
Hold downs 0 Shear NaIlmg 0
Frame 0 Gas/Propane 0
Plumbmg 0 MechanIcal 0
Comments
INSULATION
o Gas
o Foam and Seal
o ElectrIc
o Vapor barrIer
o Other
o PYA
Comments
SHEET ROCK/SHEAR WALL NAIL
Comments
OTHER
Comments
FINAL
t Sewer Final l ElectrIcal
J1 Address, Y InsulatIOn
Comments~ (e: ~
o CIvIl Fmal 0 Landscape Fmal 0 C of 0
o SIte Dramage 0 SIdewalk fI ~
Jun 22 2005 11 05AM P1
FROM YELM SEWER DEPT
FAX NO 360-458-E1166
FAX l~RAN'SMISSION
G~~
l-J~~ TO:
CITY OF YELM
P.O. BOX 479 - 931 NP ROAD NE
YELM, W A 98597
360-458..8411
J.' FAX 360-458-8166
&R~~r;:.;0 DATE: "'-~-D~
FAX#:
PAGES: I, including this
Cover sheet
From: 'KftAJD Y
Subject- Hl)LA~E" 'FINAL !YE.L.Yr. ~(t)1
COMMENTS. ~()T 4'0 1-0')..0 If) <{7ft ,L)L!G S,f:.
t/5- '5 4W ,ao
.. If you do nol teeeive all eople' or any copy IS nol legIble, please con (360) 458-84 \ 1
as soon as possible.
;
.t.1
i~r
[till
,,\~
\iJ~
.J~~
rIP
,~ I'
,w,;
~;
f~~;l~:
~~
r.u
,'ij'). 'fui
~~
~I:Ci~..
t~ .~
\'~j'
i,l
~':1
\~:i:
"h't
1~~'
:{~'*\
I.;l
,,"'11
'c\\i\.
t1r.~.li
I.:~~
'I\....'..i,[.'
'l
'~ . '.
;If
l.lf~
~!:i:
':!l.''t
~(N,
MHk
ll...~'.'.{.
'(";4.' ,
ft'~';.'
<\
, ~
'~ "
I
tj:;
\\\i
i..'\.~'"
"1
~ ',,'
l\
,~~"
\'
o
o
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-04-0202-YL
Issue Date 12/07/2004
(Work must be started within 180 days)
Receipt No
34219
Applicant:
Name: Evergreen State Builders
Phone:
253-475-6622
Address POBox 39753
City' Lakewood
State' W A Zip 98499
Property Information.
Site Address. 15820 104th Ave SE
Assessor Parcel No 85840004800
Subdivision. Yelm Terra
Lot: 48
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
Projectlriformation.
Project: Yelm Terra
Description of Work: Plan 2200 /2A Lot 48
Sq. Ft. per floor' (1 st) 1172 (2nd) 1028 (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 1,30119 993.75 307 44 5 6000 54 9000 $1,000
Building Plan Review 845 77 0.00 000 o 0000 o 0000
Mechanical Permit 8475 000 000 o 0000 o 0000
Plumbing Permit 118 00 2000 9800 7 0000 14 0000 Fixture
Sewer ERU 5,269 00 000 5,26900 5,269 0000 1 0000 ERU
Sewer Inspection 145 00 000 145 00 145 0000 1 0000 ERU
Water ERU 1,500 00 000 1 500 00 1,5000000 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 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 $10,415.71
Applica nt's Affac!avit:
OFFICIAL USE 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
",;'te,,' ;0 the St,te of W",h;'';' A'" ~/ ./
s""t",e# _ _ ~~ - D,te /2. - ""'(J4/
Firm ~
# Sets of Prints
By
~~~~~72~~~~~~~~5~~~~;~~~~~~~~':'~'m:~.;J~:t~!~:..;~~ra:~~~~~.~":-.(".-.it~~~~~~~~~~12hj8Jkr.;rt;~~
o
o
-S' ~-, \1 ...:. ';3:";"7
RECEIPT NQ
: iil'"'
I 4 ,. ).{
_ '- - V
,}3C-~53-:.:.C-::
::.?=-' -:=0\ =n
-*~*WTEN THOUSAND TWO HUNDRED SIXTEEN DOLLARS & 45 CENTS
r1E=E1 \/~c: :=RC~1/1
:::A:::: :;:::: \; J
Ai~,ic\_n'~-
-'=.,- ......,
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD, WA 98499
12/07/04 34218
10,216.45 CHECK
PENDING
SITE: 15832 104TH AVE SE L50
MISCELLANEOUS RECEIPT
DIANA
--
BLDGPRMTl175.58, PLNREV764.12, MECHPRMT78 75, PLMBPRMT132, S/ERU5269, S/INS145
W/ERU1500, W/MTR300, W/DEP40, TRAFF757.50, S/DEP50, STFEE4.50
~/2:~ (\1'-'- 3~.~2-
360-458-8J.C3
RECEiPT N,;)
,': 1 Q
_\ -t' _. ~ v
p!:: -FI\f!::n
-****TEN THOUSAND FOUR HUNDRED FIFTEEN DOLLARS & 71 CENTS
R=C=:\/-~S ~i=,C \'
s~-= F~'= \;0
';:'ilC _ \!T
"'=- '"""
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD, WA 98499
12/07/04 34219
10,415.71 CHECK
PENDING
SE L48
MISCELLANEOUS RECEIPT
DIANA
BLDPRMT1301.19, PLNREV845.77, MECHPRMT84.75, PLMBPRMTl18, S/ERU5269, S/INS145
W/ERU1500, W/MTR300, W/DEP40, TRAFF757.50, S/DEP50, STFEE4.50
DO Bc.~ .:l-S
f2:fI\ '.'\t;-. 325:)-
3SC-L~ 3-SJ.~2
') ,~ 'J ? 0
RECEIPT No ~) J 1...._
:-,,--.-\, fr-f'"""\
h=~~.*~N THOUSAND FOUR HUNDRED EIGHTEEN DOLLARS & 95 CENTS
~=Cc\v'=D FROH
D,~eo-c s=: ~ ~JC
.:l}dlCt... f\~7
p=:= .,J::.
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD, WA 98499
12/07/04 34220
10,418.95 CHECK
PENDING
SITE: 15855 104TH AVE SE L61
MISCELLANEOUS RECEIPT
DIANA
BLDPRMT1306.79, PLNREV849.41, MECHPRMT78.75, PLMBPRMTl18, S/ERU5269, S/INS145
W/ERU1500, W/MTR300, W/DEP40, TRAFF757.50, W/DEP50, STFEE4.50
o
o
Yelm School District
ATTN. SUSAN CROY
PO BOX 476
YELM, WA 88597
360-458-1900
Sold to. 16755
EVERGREEN STATE BUILDERS LLC
56622
BUILDERS LLC EVERGREEN STATE
5516 75TH ST W #1
LAKEWOOD, WA 98499
# 5618 13 12/07/04
Reg #1 SalesPerson SUSAN
Item # 2900/MITIGATION
MITIGATION OR TVF
1 @ 1,71100 1,711.00
CK #8954 FOR LOT 61
Item # 2900/MITIGATION
MITIGATION OR TVF
1 @ 1 ,711. 00 1 ,711 00
CK #8954 FOR LOT 63
Item # 2900/MITIGATION
MITIGATION OR TVF
1 @ 1, 711 . 00 1 ,711. 00
CK #8954 FOR LOT 68
Item # 2900/MITIGATION
MITIGATION OR IV.E
_____1-n. 7iTOO-1-;-7.11. 00
~CK #8954 FOR LOT 48
Item # 2900/MITIGATION
MITIGATION OR TVF
1 @ 1,711.00 1,711.00
CK #8954 FOR LOT 50
SubTotal
8,555.00
Total Due
Check
8,555 00
8,555 00
----------
----------
Thank you
PLEASE KEEP THIS RECEIPT! I I
/,
"",~q~~"'1Y"Nj~~~#!!:!:t;~~~;r;'~~~~~~.~",-~~,~l.~',''-'''''~.~;~~':';~.~fl,U_..
;ri:~egt.2~tiO ~~}'~'3~"
25$'''4318:3
'..U.'.....
""'.'^ '.t:!. "f"" .~. -." RES!O '. ENT1'AL:
~."....~.,.O"
. . .
!;.~;
I
I . . .
j LOT 4~8'
I" . p ..'
E: ~,mR' 1':'0 DID. "N' ...........s..T.."':A.........~..............,nf'm..17:\:rnD.ei
. .;",'VD', .' :l~D'-: : <.. .,N4.+'Q p~V.~~:~~~l
. YEDM'~RRA .
.., . '.
YELM WA
. . '_ .. . .. I '.
1
SITE PLAN A?PROV:A;~
'0 j,'#;CNlU;41'l!I'5IMilIoIHL\Ivis.!'4'l:~ I
~",(~ ..
1\\11'
~ ..
--;
';4 j.,.;:..,__.~'_-_ '-:......._
-~(>>I ...
.~
~ O'IJIZ'Pl' A
_. ,,':' ....., .;.:...... " ,,', ,:' '.'
",'.' '. .. ...;i.... i',":':"'"
. jf C's ".".
, \.i ..- ~ J
:Jf'ti.~._
~. .' "~~
ei 200+ b'A$GAOt ~E;$JQ6;NTIA~ OE5~CN, tNt;;:;
JI"1I ON4'1!1I10'!:il ~i\J(p.'\1~,r;~!~I/!~I'"CWIP~1.l. ~~~U4pq~'~"'~!t:'lQ 'Url,ttu~~rt
...~~. t;eWll~ MI! '~.~.u,;~". .niti Qih"': Ala; roc ~n;il.. 'C11l ,m..;:rr.e.iS
'~qt '''t Ul" k'J.vD'<.!llllRlrr'Op lnlt ':11l:Ht. ,
'.M
'.II/~Y 10b4':IQI.Z~:'I'N";II~@.'
,
,.' J.,.
11
i
,
'F 1- ~!;
i,
"..I'
il
"
)
';I
'1'
i
}:
'I,
.~ l~
"!I.
"
.~.~",
'..,;'....'..'. ;
. <'i, .... ,I
. t., :,1,
Nb'~T8i'
~... ~. ,l., f
~ Ii
d
\~
(
$q~j' '[. ~..
o
o
CITY OF YElM
RESIDENTIAL BUilDING PERMIT APPUCATION FORM
Project Address: 1... C+ Parcel #"
Subclivisioll "\ ~\ 1M -t~(,"t'1\ Lot #" 4-~ Zoning; S:\I\~ \ ~:l\",^
.F1'New Construction 0 Re-Model/ Re-Roof / Addition 0 Home Occupation Sign
o Plumbing 0 Mechanical 0 Mobile / Manufactured Home Placement 0 Other
Project Description/Scope of Work. 5 ~ <<;;::> \ ~~~ \1. u \ de-v\.'"\'. +\.
Project Value. I 2~ , 50() , f(j
Building Area (sq. ft) 1st Floor I \11- 2nd Floor 10'28 Garage t..t<&J Deck
Basement \(:.. Carport..,... Patio 'Lj b
# Bedrooms ~ # Bathrooms ~'j'1... Heating.G/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? ,J.) 0 If yes, a
completed environmental checklist must accompany permit application.
BUILDINGOWNERNAME ~\'l~teer1 'O;.~~ ~\\dtr~ /....L. L
ADDRESS~815 I()(yft> $1" :>. Wi ~,.Ht-€. 2.1\- EMAIL 1
CITY L-lTtt.ewo-ov) S1 A 1E vJ 1't ZIP; 8<-t 111 TELEPHONE Z-5?>-I-J 75- 66 z. 2
GENERALqON'tRAGTOR $~e.. I't-~ Qw\l\e( TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # F\.le("5Sb CJBO fbEXP DA TE~ITY LICENSE #
'.:..IT TELEPHONE ~5~-..!:r>1- '700
EMAIL
ZIP7Prf'iS FAX ~5.:o-...536- Of t~'
EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
ZIP
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable
I hereby certify that the above Informatkm Is correct and that the construction on, and the-occupancy and the use of the
above described prope will be in accordance with the laws, roles and regulations of the State of Washington and the
City ofYelm.
/7 -/6 ~()'1
plica Signature {: Date
Owner I Contractor ~~f:> 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
Yelm, WA 98597
(3GO) 458-3835
(3GO) 458-3144 FAX
www.ci.yelm.wa.us
!
o
o
Evergreen State Builders lLC (license # EVERGSB980PB)
5700 _1001h Street S.W, Suite 630, Box 197, lakewood, WA 98499
253-475-6622 (Fax 253~4'15-6127)
DESCRIPTION OF MATERIALS for
YELMTERRA
8' ceilings on first floor
Siding:
8" pre-primed James Hardie lap siding on front, James Hardie single wan
sidmg sIdes and back; James Hardie shakes or shake panels as accents
front elevatlOn per plan.
Roofing:
Architectural ComposItion roof.
Windows:
Vinyl windows to code and as per plan.
Driveway:
Broom finish.
PatiolWalkways:
Broom finish.
Cabinets:
Oak cabinets, flush paneL
Doors:
Embossed packa e.
Exterior:
Insulated steel, 0 fiberglass.
Millwork:
Embossed package.
Window Wrap:
Stool and Apron my
Plumbing:
Kitchen Sin\<, 33x22, 31 ole, dOU,b1e-Sink. Stainless with chrome delta faucet.
Lavatory:
/ill Powder Roo I. white with Delta. chrome faucet.
I
e Hall Bath. Kilgore white sink with Delta chrome faucet.
/ill Master Bath; (2) 20x 17 white with Delta chrome faucets.
II> Tub Valve~aster bath. Delta chrome or eqUivalent.
. Tub/Shower alve Main bath: Delta tub and shower valve.
.. Shower Valv . ,Master: Delta or equivalent.
<!II Toilets. whit, per plan.
Bath enclosures:
Hot Water Tank:
Hosebib:
Hardware:
Bath hardware:
Flooring:
Countertops:
Painting:
Appliances:
Wirmg:
c
o
Page one of two
Master bath: Clear glass door on separate shower with chrome trim.
Tubs: Fiberglass white.
Gas 50 gallon.
Two per plan.
Locks interior:, Chrome
.Locks exterior: Chrome
Towel bars: Chrome
Paper holders: Chrome
Carpet: Dining room, living room, stairs, bedrooms, closets, 6tb., 1/2"
rebond pad.
Vinyl: Utility room, han bath and Entry
Laminate. Whole house
Exterior Trim: \Vhite or color from approved list.
Extenor Body: Flat solid body pamt from approved list.
Front Door~ Enamel, white or accent color from approved hst.
Interior Walls: Drywall sealer coat, then one coat flat latex.
Kitchen and batllro~ Low sheen enamel.
Range/Oven. Whirlpool whIte.
Dishwasher: Whirlpool Self Clean, WhIte.
DIsposal: 1/2 HP.
Icemaker: Refrigerator space plumbed for icemaker.
Microwave. Whirlpool whIte
Phone (2) cabl~~ (2)
]loage two of two