20040198
Apr 04 05 03:30p
Jon Yanasak.
360-458-7937
p. 1
CFF'Y OF- 'lELM-
P:O..HOXA'zg'- 93TNP R.OAD.NE
N) YELM, W A 98597
Q/' f\ ~ 360-458-8411
("\ ~ I rt' \JS \ - \ FAX ]60-458-&166
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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 ofVelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-04-0198-VL
Issue Date. 12/03/2004
(Work must be started within 180 days)
Receipt No
34197
Applicant:
Name: Yelm Property Development
Phone
458-0544
Address 16422 Middle Road SE
City' Yelm
State. WA Zip 98597
Property Information
Site Address 9922 Greenleaf Loop SE
Assessor Parcel No 84070004300
Subdivision: Willow Glen, Phase II
Lot: 43
Contractor Information
Name. Applicant
Address
Contact:
Phone
City'
State'
Zip'
Contractor License No YELMPDL00302
Expires 02/20/0551
Business License.
ProjeCt Information
Project: Willlow Glen, Phase II
Description of Work: 1296 SFR-Lot 43
LID Sewer Connection
Sq. Ft. per floor' (1st) 1296
(2nd) 0
(3rd) 0
Garage 398
Basement 0
Heat Type (Electric, Gas, Other)' GAS
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
--------------------------- -------------
Building Permit 50-100k 951 65 643 75 307 90 7 0000 43.9850 $1,000
Building Plan Review 397 08 000 0.00 o 0000 0.0000
Mechanical Permit 71 75 000 000 o 0000 o 0000
Plumbing Permit 9000 2000 7000 7 0000 10 0000 Fixture
Sewer ERU (LID) 2,694 00 000 2,694 00 2,694 0000 1 0000 ERU
Sewer Inspection 145 00 000 145 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
Sewer Deposit 5000 5000 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
State Building Fee 450 450 000 o 0000 o 0000
TOTAL FEES $7,001 48
Applicant's Affadavit:
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
:::::::;Olh.Z~ D,I. ,~
Firm
# Sets of Prints.
Final Inspection:
Date I./~Lf-'o r
By' --.1d1 .
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Yelm School District
ATTN. SUSAN CROY
PO BOX 476
YELM, WA 98597
360-458-1900
Sold to: 16616
WILLOW GLEN 2
WILLOW
GLEN 2 WILLOW
16422 MIDDLE RD SE
YELM, WA 98597
# 5613 12 12/03/04
Reg #1 SalesPerson SUSAN
Item # 2900/MITIGATION
MITIGATION OR TVF
1 @ 1,645.00 1,645.00
Lot 43 Willow Glen 2 ck Yelm Prop DEv 67
35
SubTotal
1,645.00
Total Due
Check
1 ,645 .00
1,645 00
----------
----------
Thank you
PLEASE KEEP THIS RECEIPTI!I
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"I'~ CITY OF
~~I YELM
~ PO Box 479
Yelm WA 98597
,Mo,.,.. 360,458-8403
RECEIPT No 34197
lVED
....SEVEN THOUSAND ONE DOLLARS & 48 CENTS
RECEIVED FROM
~LM PROPERTY DEV LLC
5422 SE MIDDLE ST
~LM. WA 98597
[TE:9922 GREENLEAF LP SE L43
DATE REC NO
12/03/04 34197
AMOUNT
7.001.48 CHECK
REF NO
6736
MISCELLANEOUS RECEIPT
DIANA
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JDPRMT951.65. PLNREV397.08. MECHPRMT71.75. PLMBPRMT90.S/ERU2694. S/INSP145.
IERU1500. W/MTR300. S/DEP50. W/DEP40. TRAFFIC757.50. STFEE4.50
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Received
NOV 3 0 2004
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address' 99.U. 61"ee-h1J L.ce.q Sf PaiceI #"
Subdivision: W I ~low 'Ie,.. V\ J.II:- Lot #" Lf3 Zoning; R"" b
~ew Construction 0 Rs-Model/ Rs-Roof / Addition 0 Home Occupation Sign
o Plumbing 0 Mechanical 0 Mobile I Manufactured Home Placement 0 Other
Project Description/Scope of Work: €rr>'t)1t ~i /~ #rm<<:
Project Value. 11" (I.{ J. K
Building Area (sq ft) 1st FIoor.J..~'1h 2na Roor Garage Deck
Basement Carport Patio
# Bedrooms_ # Bathrooms_ Heating:~THER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? ,J6 If yes, a
completed environmental checklist must accompany permit application.
i3tli'ffilNGteWtNEEfNAME: . LLC
ADDRESS -~~i~~li 2;;:- ,M" eM It ~ S
CITY STAI E Wfl- ZIP q'isq, TELEPHONE
1\HGEritEG:flENGJNEEEt Ft'tlc-. t.-t'JU.. UCENSE #
ADDRESS~~;;(~. e 4'e~
CITY OI...t1t.III'e STATEWt\- ZIP 1&'~J TELEPHONE ..3(.0 '15"1:.- ot!J35"
BENEAAillcbNtBi\ci::QB 'lPj)L Lc.
ADDRESS..... .~i&"Cii.~-~,cLdlL- f2..J. Sf
CITY YfJbWL STATE wrt ZIP
CONTRACTOR'S LICENSE # "if'i>l-ov5c'L
TELEPHONE 3f;() 4>Sh'-oJ q'i
Q35'''I7 FAX dW LES f) ~ o58lf
EXP DATE2//3,k4C/TY LICENSE #()'i-OCu'J!j
PLUMBING'CONTRACTOR wbltie K~i'~'" , TELEPHONE d,o 8P-t'- Ito2- '1
AD[>R'i~:SS 77Ii )-". '('0 '--'1- /.el;,p sa ~ - -
CITY Yej(J'\ ~ATEwA ZIP1K~7 FIV< ",Go 81'1- /t?3/
CON'fRAGTOR'S LICENSE it lVltrfE.( PeeS's P61 EXP DATE!i!!k CITY LICENSE ::
MECHANICAL CONTRAC I..OR 1-b-i 2(lw1 t-k('~ ~Gx>illt) TELEPHONE
ADDRESS ..34$'16' 7fuJwAX vI? I E
CITY Ea..tcnvili< STATE wit ZIP 'j23~g FAX
CONTRACTOR'S L1CENSE#Ho.('/ZtlC9~?K EXP DATEI . ITY LICENSE ##
V Copy or mitigation agreement with Yelm Comm'Unity Schools, if applicable
I hereby certify that the above information is correct and tha.t the construction on, and the occupancy and the use
oj tile g~ove described properrl will OS in accordance with the laws. rules and regulations of the State cf
Washington and the City of Yelm.
Ddh. ~4
Applicant's Signature
Owner I Contractor I Owner's Agent I Contractor's Agent
IIlJo/t!Jy
Date
(Please circle one.)
. .AII petlljits are non-transferable and will expire if work authorized by such permit is 'Q.ot
"-'~egun within 180 days of issuance, or if Vlork is suspended or abandoned for a period of
180 days
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