20040197
tw~lB='-'~
CIT'l Of 'lEI-t.'I- BUII-OING OEP/>.RTt.'IENT
RESIOENTI/>.I- CERTlfIC/>. TE Of ocCUP />.NC'l
8Ui\din9l\ddress
~
~
~~
~W~53
~
~
owner Name
owner I\ddress
p\an Number
8ui\din9 permit Number
I\reas \nspected
None
June 15 2005
Remar\<.s.
----
N\ Code ReQuired
o ate
specia\ conditions
8ui\din9 officiat
. . h Inlemalional Residenlial Code (coapler
1his s\lUc\o,e is in complIance ~llh ~i: Ion Slale Building Code counCIl pursuanl
5,.51 WI\C) as adopted b,/ \2"'7e ~s10 ~z RCW elleclNe Jul~ '. Z004
to c",apters 19 anu '
G. car\Son
~~\@
G
c
c
PROJECT
PERMIT NUMBER
ADDRESS
SET BACKS Date
Front
Rear
S I de/Flankmg
SIde
FOOTING REBAR
Comments
CITY OF YELM INSPECTION LOG
W &3 YJd-- ~~
eY/ a/??
/5' ?tf3 / tf tit- tJ- /J ve ~
FOOTING WALL
2A;> D 12" 0 6"
sfA' JM 6" ff8"
? 0 other 0 other
,. -- D reqUIred vents /::2--
/ Dale ~ WALL REBAR / Dale ~
Comments
o Gas
o Foam and Seal
D Electnc
D Vapor barner
o Other
o PYA
COMBINED FRAME/ EXTERIOR SHEAR WALL INSPECTION
Hold downs 0 Shear NaIlmg 0
Frame D Gas/Propane 0
Plumbmg 0 Mechamcal 0
INSULA TION
Comments
SHEET ROCK/SHEAR WALL NAIL
Comments
OTHER
Comments
~~ ~I L~
~ ttf;:)l
FINAL
1 Sewer Final
Y Address
Comments
J Electncal
~ InsulatIOn
D CIvIl Fmal
D SIte Dramage
o Landscape Fmal
~ SIdewalk
o C of 0
o
o
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-04-0197-YL
Issue Date 12/07/2004
(Work must be started within 180 days)
Receipt No
34221
Applicant:
Name Evergreen State Builders
Phone:
253-475-6622
Address. POBox 39753
City. Lakewood
State WA Zip 98499
Prqperty Inform.Hion:
Site Address. 15843 104th Ave SE
Assessor Parcel No 85840006300
Subdivision. Yelm Terra
Lot: 63
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: 1675/3 Lot 63
Sq Ft. per floor' (1 st) 908 (2nd) 767 (3rd) 0 Garage 701 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 1,138.62 993 75 14487 5 6000 25 8690 $1,000
Building Plan Review 74010 000 000 o 0000 o 0000
Mechanical Permit 78.25 000 000 o 0000 o 0000
Plumbing Permit 118 00 2000 98.00 7 0000 14 0000 Fixture
Sewer ERU 5,269 00 0.00 5,269 00 5,2690000 1 0000 ERU
Sewer Inspection 145 00 0.00 14500 145 0000 1 0000 ERU
Water ERU 1,50000 0.00 1,500 00 1,5000000 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 7500000 1 0100 Peak PM Trip
Sewer Deposit 5000 50.00 000 o 0000 o 0000
State Building Fee 450 450 000 o 0000 o 0000
TOTAL FEES $10,140.97
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 Washin ton. I~/ ~
Signature ~~ Date ,1-'.0
OFFICIAL USE ONLY
# Sets of Prints
By'
Firm
~
q~f~~~-.f>a...~~k~\~~~~&~-kaS-6-~~~~:!';'F~~~~~;~....:....~\Mii:-~.t~.i-i-.XJ;~~~j-&-~~~~~~~,1~~'i'-~~~~.;n;..~~~~k'W'~3~..t:'~~fa:;~:C''f,~::;~
:t;~~~?1 CIT) 01:-
rC,/;;~-<%Y t L ~ 1
v ::,... f -', -.....'.l ::: ~ _ _
( -s-, I
· ----/ r:J'
_I-__~-"'- .. -'-~ 'co 0,-0
,.:.:. ':..:--".;;. y -..... -
~.Q~
o
o
ReCEIPT No
:: ~ ? ;) 1
..... --.....
~-=!= .......~!\ f~rJ
-'If*'*.nrEN THOUSAND ONE HUNDRED FORTY DOLLARS & 97 CENTS
'~=:=~. E= i=~'=ii\;i
C:~T= ~=:..... ~,~::::
~f...'!:... ~-,.-
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD WA 98499
12/07/04 34221
10.140.97 CHECK
PENDING
SITE: 15843
SE L63
ISCELLANEOUS RECEIPT
IANA
BLDGPRMTl138.62. PLNREV740.10. MECHPRMT78.25. PLMBPRMTl18. S/ERU5269. S/INS145
W/ERU1500. W/MTR300. W/DEP40. TRAFF757.50. S/DEP50. ST FEE4.50
el~!~-f~<<f~~~lf~~k~t1;r~&lJt~~~~~1t1;~fl~S!~~~#~~~4~~~rr~~~m~~~1~1~~\1~~~~i~)
i/(~~ CIT\ .0. I:-
f.;~ I \lr-, N" 'f
_ .... ~y:--" - ..:t :"'1
I '/1'" I - -.--'-
~~ /",~ "''=:''- :; ~ - ~ - -
~>~
''''''''~M
.. ,"_' 0.. I
aT,-~:'_~""-':........J
RECE!PT N,::,
" , ~j:)')
-' ~ - :-. ~
:::::: = ~ ;::-~' =r'I
-*'If*~~EN THOUSAND THREE HUNDRED TEN DOLLARS & 83 CENTS
-~-..- ',..-- --..- ~
-.- -, - -- .
-'- -. - '-
::;,=-' " =
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD WA 98499
12/07/04 34222
10.310.83 CHECK
PENDING
SITE: 15801 104TH AVE SE L68
MISCELLANEOUS RECEIPT
DIANA
BLDGPRMT1229.14. PLNREV798.94. MECHPRMT84.75. PLMBPRMT132. S/ERU5269. S/INS145
W/ERU1500. W/MTR300. W/DEP40. TRAFF757.50. S/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 @ 1,711.00 1,711.00
CK #8954 FOR LOT 61
Item # 2900/MITIGATION
MITIGAIION-QR-~V~
/------ 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 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
----------
----------
Thank you.
PLEASE KEEP THIS RECEIPT' I I
111e912a~4
11'00
25328'\'3183
..'........U
.. .
~;.=t~~,,'~)~::...,.~.-r..ar~~~,rs,r:p:;;:~'';''':;'''':'....,''''';''I.;'''''''''''''''TJ~'''~;; "..,~~.;~~,..::..;., :-:-;.;:;:::;.:::~-:~~.=:-::~~;
cAscME RE?lOENi .L"L ....
,. 0
;........::-' <...:;~",~....-;~J.t-'J<".j"~~~"p,:~~:e.:o:I';:W:"'~_:'I';'$"''''
Lor~-3
, E;VBR~R.BBN $TA'mBIJ.lILD~S
i ~T1'\K. ~;o;n,l'f,
I J; .1:4:.LUYJ; J..I;i.:L'\;I.~
YELIV1 W:4.
. .... ,J
"-;';'"". ., ,
.<O~
<</
"
'~ ;
61'0' I
'0,;1
/(l
~lEPLAN APPROVAL._,
~"''''ll'' OJ "liOMlIl /1tIt'..o lU'_
"r.I,\'\I(n:Vl,\t\t~fl!' ..-
~
'O!\J>
......--_... --.-
----, l~! ;;L,.~--
_.,--......-=-7.~("~"r-
~51t:E PLA~
_ . .. . ....,. t
o 2GCI'~CA:5<Zi\I~E-RE~[d,~r-l'riA. OES{QN:\Nt;
.@.....'..."..
. " '.-" .
"'l
, ,. ,.
:~O~TJ:rI,
SCA\;.;E l' ~ ~l
rH1~ gfW'IU'Ql')R'~Ill"DWCUtjr..P'qO"'JII(IHM~,,:'~:ntji, iil:mwiO Dt"CCUr.'~Tr.'
';'0 /l\l:i':1/;il.l.~NY .1l'1i'eti.cl'tl~ilJa~U~~~;UIi' uWMill!l) Alia 'i~,..;.,c~1rr:t ~lcl~
~ ~Wr (it;~-t.,or\1lc:('. 11 . . .
11/9/ ~fiC.7.t:4~N~di~
\
-^~---- ,~"I'-''''-''''''''''''''''''''''''
~..,<.,.,.,.",,~---'
~--------------- -
o
o
~
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPUCA TION FORM
Project Address: 1... C+ ~ ~ Parcel #.
Subdivision. '\ ~\ vY'\ -t~(,t'1\ lot:ff: to 1.? Zoning; s;:'^~, ~Il\;,\
z(New Construction 0 Re-Model f Re-Roof f Addition 0 Home Occupation Sign
o Plumbing 0 Mechanical 0 Mobile f Manufactured Home Placement 0 Other
Project OeSCri~ion/scope of Work. S ''f'\ c;:, \ ~{\"'"
Project Value~ ( t q ) 0 01>
Building Area (sq. ft) 1" FloorC;I\~. 2"" FIOO;::z6:L Garage ~ Deck
Basem~ carport~patio 2.\ 6
# 8edrooms~ # BathroomsZt2- Heating.~THER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? ~ 0 If yes, a
completed environmental checklist must accompany permit application.
\1. ~ '\ de..V\.--t, .1\-\
BUILDING QWNER NAME 'i'\\ ~teer\ \;.~ ~ ~\ \d t.f"s, L.. L. t..-
ADORESS"3:.8/5 )()t.:>'f~ SoT :>. Wi ~0tt-e. 2.1\- EMAtL 1
CITY '-I\-ttewc()'~ STATE w ft ZIPe:, 8<-t, ~1 TELEPHONE Z-S?>-Li7S- 66 Z 2
GENERALC,QNt~CTOR -:5.~e... tr-~ C~'l\~ TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # iJe(( ~ &J80fbEXP DATE~ITY LICENSE #
kf\- TELEPHONE 2-5~- ...:537- lJ.:X)
EMAIL
ZIP'1Pf:/Y>" FAX 2..."5.3-..536- <Zf f.fo{,
EXP DATE CITY LICENSE #
ZIP
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable
J hereby certify that 'llie above information is corre<:t 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 ofYelm.
:.i- . .JJ-t 6 --ot-!
plica 'Signature , . Date
Owner / Contractor ~e(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
(3GO) 458-3835
(3GO) 458-3144 FAX
www.ei.j'e]m.wa.u&
105 Yclm Avenue West
PO Box 479
Yelm, WA 98597
~---- ~ "-
o
o
Evergreen State Builders LLC (License # EVERGSB980PB)
5700 _1001h Street S.W, Suite 630, Box 197, lakewood, WA 98499
253-475-6622 (Fax 253~475-6127)
DESCRIPTION OF MATERIALS for
YELMTERRA
8' ceilings on firstfloof'
Siding:
8" pre-primed James Hardie lap siding on front, James HardIe single wall
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.
PatiolWalkways:
Broom finish.
Cabinets:
Oak cabmets, flush paneL
I
Embossed package.
Insulated steel, oj fiberglass.
Embossed packJe.
I
Stool and Apron only
Doors:
Exterior:
Millwork:
Window Wrap:
Plumbing:
Kitchen Sink: 33x22, 3Iole, double-sink. Stainless with chrome delta faucet.
Lavatory:
. Powder Roo . whIte wIth Delta chrome faucet.
Clll Hall Bath~ Ki gore white sink with Delta chrome faucet.
tllI Master Bath. (2) 20x 17 white with Delta chrome faucets.
" rub Valve. aster bath. Delta chrome or eqmvalent.
ell Tub/Shower alve Main .l?ath. DeIta tub and shower valve.
.. Shower Valv . Master: Delta or equivalent.
<Ill Toilets: whitb, per plan.
Bath endosures:
Hot Water Tank:
Hosebib:
Hardware:
Bath hardware:
Flooring:
Countertops:
Paintmg:
Appliances:
Wiring:
c
o
\
Page one of two
Master bath: Clear glass door on separate shower with chrcme trun.
Tubs: Fiberglass whIte
Gas 50 gaHon.
Two per plan.
Locks interior:. Chrome
Locks exterior: Chrome
Towel bars: Chron1e
Paper holders: Chrome
Cwpet: DinIng room, Hving room, stairs, bedrooms, closets, 6 lb., 1/2"
rebond pad.
Yinyl: Utility room, han bath and Entry
Lammate: Wholl~ house
Exterior Trim: "White or color from approved hst.
Exterior Body:. Flat solid body pamt from approved list.
Front Door~ Enamel, white or accent color from approved list.
Interior Walls: Drywall sealer coat, t.hen one coat flat latex.
Kitchen and battrrooms.:. Low sheen enamel.
Range/Oven. Whirlpool whIte.
Dishwasher: Whirlpool Self Clean, WhIte.
Plsposal: 1/2 HP
Icemak.er:. Refrigerator space plumbed for icemaker.
Microwave. Whirlpool whIte
Phone (2) cabh:: (2)
}Jlage two of two
~