20040199
CITY OF YELM - BUILDING DEPARTMENT
RESIDENTIAL CERTIFICATE OF OCCUPANCY
Building Address 15855 104th Ave. SE
Owner Name Everqreen State Builders
Owner Address P.O. Box 39753
Lakewood. WA 98439-0753
Building Permit Number BLD-04-0 189- YL Plan Number 2229/2
Remarks
Areas Inspected All Code Required
Special Conditions None
Building Official G. Carlson Date Mav 26. 2005
This structure is in compliance with the International Residential Code (Chapter
51-51 WAC) as adopted by the Washington State Building Code Council pursuant
to Chapters 19.27 and 70 92 RCW, effective July 1, 2004
FROM YELM SEWER DEPT
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FAX#:
FAX NO. 360-458-El166
Ma~. 25 2005 03 22PM P1
FAX TRANSJ\1ISSION
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MAY 2 7 2005
CITY OF YELlv1
P.O. BOX 479 - 931 NP ROAD NE
YELM, W A 98597
360-458-8411
FAX 360-458-8166
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DATE: /-5' j, )'''-0::::)
PAGES. I, including this
Cover sheet
From: K!\AJ0Y
Subject: t- \ ~)A L- ~ l? !_VY\ TEk {Cfl
COMMENTS: ) T' I I 1C"':-:i-55"- jO'/1-'r1.. S 16 .
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** If you do not receive all copIes or any copy IS n:>t legIble. please call (360) 458-8411
as soon as pos!'nble
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PROJECT
CITY OF YELM INSPECTION LOG
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Y.rt."vv- /,1T FA.-
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W~I
PERMIT NUMBER
oy~ 0/97
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SF
ADDRESS
/sgsJ
SET BACKS Date FOOTING WALL
Front Z- (S> 0 12" 0 6"
Rear . ?i? )1-16" ~ 8"
Slde/Flankmg /3, S- 0 other 0 other
Side? 0 reqUIred vents IV
FOOTING REBAR J Date~WALLREBAR /Date 'O-(X2-
Comments U \~ u-k I I
COMBINED FRAME/ EXTERIOR SHEAR WALL INSPECTION
Hold downs 0 Shear Natlmg 0
Frame 0 Gas/Propane 0
Plumbmg 0 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
!)NAL 4
Il Sewer Final Pf. Electncal
! Address f InsulatIOn
comments~ 5k}<
I
o Civil Fmal
o Site Dramage
o Landscape Fmal ~ C of 0
o Sidewalk
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360)458-3144
Permit No
BLD-04-0199-YL
Issue Date 12/07/2004
(Work must be started within 180 days)
Receipt No
34220
Applicant:
Name. Evergreen State Builders
Phone:
253-475-6622
Address POBox 39753
City. Lakewood
State, WA Zip 98499
Property Information
Site Address, 15855 104th Ave SE
Assessor Parcel No 85840006100
Subdivision. Yelm Terra
Lot: 61
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 2229/2, Lot 61
Sq Ft. per floor' (1 st) 1038
(2nd) 1191
(3rd) 0
Garage 440
Basement 0
Heat Type (Electric, Gas, Other). GAS
Fees
Item lIem Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
--------------------------- -------------
Building Permit 100-S00k 1,30679 993,75 31304 5 6000 55 9000 $1,000
Building Plan Review 849 41 000 000 o 0000 o 0000
Mechanical Permit 7875 000 000 o 0000 o 0000
Plumbing Permit 118 00 2000 98,00 7 0000 14 0000 Fixture
Sewer ERU 5,269 00 000 5,269 00 5,269 0000 1 0000 ERU
Sewer Inspection 14500 000 145.00 1450000 1 0000 ERU
Water ERU 1,50000 0.00 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 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 $10,418.95
Applicant's Affadavlt:
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
registered in the State of Washington,
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Signature p--~"" Date I.~ -04t
Firm
# Sets of Prints,
Final Inspection:
D'le'~,.,('
BY:~
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Yelm 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 ST W #1
LAKEWOOD, WA 98499
# 5618 13 12/07/04
Reg #1 SalesPerson SUSAN
Item # 2900/MITIGATION
MITIGATION OR TVF
,_.--..-.-1...-@.-- 1.,.7J.1;.00--..... 1,711 00
C CK #8954 FOR LOT 6L:-->
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 1,71100
CK #8954 FOR LOT 68
Item # 2900/MITIGATION
MITIGATION OR TVF
1 @ 1 ,711. 00 1, 711. 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
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----------
Thank you.
PLEASE KEEP THIS RECEIPT! I I
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RECE!PT No
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, -*~*-TEN THOUSAND TWO HUNDRED SIXTEEN DOLLARS & 45 CENTS
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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
--
BLDGPRMT1175.58. PLNREV764.12. MECHPRMT78.75. PLMBPRMT132. S/ERU5269. S/INS145
W/ERU1500. W/MTR300. W/DEP40. TRAFF757.50. S/DEP50. STFEE4.50
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-***"*TEN THOUSAND FOUR HUNDRED FIFTEEN DOLLARS & 71 CENTS
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EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD. WA 98499
12/07/04 34219
10.415.71 CHECK
PENDING
SITE; 15820 104TH AVE SE L48
MISCELLANEOUS RECEIPT
DIANA
BLDPRMT1301.19. PLNREV845.77. MECHPRMT84.75. PLMBPRMT118. S/ERU5269. S/INS145
W/ERU1500. W/MTR300. W/DEP40. TRAFF757.50. S/DEP50. STFEE4.50
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';~~r**~N THOUSAND FOUR HUNDRED EIGHTEEN DOLLARS & 95 CENTS
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EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD. WA 98499
12/07/04 34220
10.418.95 CHECK
PENDING
SITE: 15855 104TH AV
MISCELLANEOUS RECEIPT
DIANA
BLDPRMT1306.79. PLNREV849.41. MECHPRMT78.75. PLMBPRMT118. S/ERU5269. S/INS145
W/ERU1500. W/MTR300. W/DEP40. TRAFF757.50. W/DEP50. STFEE4.50
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EVERGREEN STATE BU11J)'ERS
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YELM~
YELM WA
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SllIPLAN -APPROVAL
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CITY OF YElM
RESIDENTIAL BUilDING PERMIT APPUCATION FORM
Project Address. 1... C+ (; \ Parcel #'
Subc\ivisioll '\ ~\ W\ -T~ (,t'i\ Lot #- (f; I Zoning. ~ '^<b \ ~i\\M
J?f"New Construction 0 Re-Model / Re-Roof / Addition 0 Home Occupation Sign
o Plumbing 0 Mechanical IJ Mobile / Manufactured Home Placement 0 Other
Project DescriptionlScope of Work: $ \1"-:::> \ ~~""'" \1. f,U. \ de...\A..--t' +\
Project Value. , 1- ct \ L-{'1 to?"..QQ..
Building Area (sq. ft) 1st FIOOr-107>e, 2nd FloorJ.l5l Garage '-t'-tO Deck 'f-
Basement '1' Carport 'f- Patio 2/6
# Bedrooms-=l # Bathrooms~2- Heating@nHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? ~ If yes, a
completed environmental checklist must accompany permit application.
BUILDINGOWNERNAME T-~ ~teer\ '0;.-\ Itt-e ~\ \d tf"S- (... L. "
ADDRESS"3-815 )t)(Jxfr> S-T ~. lJi .!:.\'.Ht'€. 2.~ EMA1L 'f
CITY Ll\1tewc-o~ STATE vJ It ZIP 0:; 8<-1 ~'1 TELEPHONE Z-5~-'-I7S- 66Z"2-
ARCtllTECT/EN<3INEER C4t. ~e ~\'~e LICENSE #
ADDRESS 102.. S;:, "2-6 .s: ('c (:.EMAtL :2-5.3- 2-8'1- "'3.f10
CITY (A-c~ l"\- STATE l!J Jt ZIP ~ ~ 0.2. \.:fELEPHONE (JtS.c.~e ~ t''K.. N~' L
GENERALGQNT~QTOR $~€- rr--:::. Oc.....:h/\e.(" TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # tfve('t\S1o '180 fbEXP DA TE~ITY LICENSE #
\dT TELEPHONE ~6~ 53,- '1tt)
EMAIL
zIP'1Ff1Y5' FAX 2..5.3-.,536- Of t-lbt:
EXP DATE CITY LICENSE #
I 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 Information 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, rules and regulations of the State of Washington and the
City of Yelm.
~ n-16-6~
plica Signature ~ ~ Date
Owner I Contractor ~ets Agent Contractor's Agent (Please circle one)
All permits are non~transferabJe and will expire if work authorized by such pennit is not begun
within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days
(360) 458-3835
(360) 458-3144 l"AX
www.ci.yelm.wa.us
10.5 Yelm Avenue West
PO Box 479
Yelm, WA 98597
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Evergreen State Builders LLC (License # EVERGSB980PB)
5700 _100th Street S.W, Suite 630, Box 197, lakewood, WA 98499
253-475...a622 (Fax 253~475-6127)
DESCRIPTION OF MATERIALS for
YElMTERRA
8' ceilings on firstflool'
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 elevatIOn per plan,
Roofing:
Architectural Composition roof.
Windows:
Vinyl windows to code and as per plan.
Driveway:
Broom finish.
Patio/Walkways:
Broom finish.
Cabinets:
Oak cabinets, flush panel.
Embossed packale.
I
Insulated steel, 0' fiberglass.
Embossed packJe,
Doors:
Exterior:
Millwork:
Window Wrap:
Stool and Apron nIy
Plumbing:
Kitchen Sink: 33x22, 3- ole, double-sink. Stainless with chrome delta faucet
Lavatory:
. Powder Room.. white with Delta chrome faucet.
CIIl Hall Bath~ KJgore white sink with Delta chrome faucet.
l\ll Master Bath;. (2) 20x17 white with Delta chrome faucets.
. Tub Valve, aster bath. Delta chrome or eqmvalent.
III Tub/Shower alve. Main bath: Delta tub and shower valve.
.. Shower ValvJ. Master: Delta or eqUlvalent.
. Toilets. whit, per plan.
\
Bath enclosures:
Hot Water Tank:
Hosebib:
Hardware:
Bath hardware:
Flooring:
Countertops:
Painting:
Appliances:
Wiring:
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Page one of two
Master bath: Clear gla..~s 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
C;gpet: Dining room, livmg room, stairs, bedrooms, closets, 6 lb., 1/2"
rebond pad.
Vinyl: Utility room, hall bath and Entry
Lammate: Whole house
Exterior Trim: 'White or color from approved list.
Exterior Body:. Flat soUd body paint from approved list
Front Door2 Enamel, white or accent color from approved list.
Interior Walls, Drywall sealer coat, then one coat flat latex.
Kitchen and bathrooms: Low sheen enamel.
Range/Oven. Whirlpool wlute.
Dishwasher: Whirlpool Self Clean, White.
PlSposal: 1/2 HP
Icemaker: Refrigerator space plumbed for icemaker.
Microwave. Whirlpool whIte
Phone (2) cable~ (2)
l"age two of two