20040196
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CIi'f of' 'fELtA _ B\.lILOING OEP /).R1"tAEN1"
RESIOEN1"I/).L CER1"If'IC/). 1"E of' OCC\.lP /).NC'f
~.reas \nsgected
spedal conditions
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Building .Mdress
Building perfl'\it Nufl'\oer
plan Nufl'\oer
owner Nafl'\e
Owner f>.ddress
Refl'\arY$.
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1\11 Code ReQuired
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Date
Building OUicial"
. . h Inleln.(\on.' Residenli.' Code lCh.plel
,his slluclUle is in conWli.nce ~il~~,; Ion SI.le Building Code Council pUlSu.nl
5~S\ Wf>..C) as ado9ted 0"1 tn7ea d 70 ~Z RCIN effeclive JUW ~. Z004
to cnapters ~9.2 an .
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FAX TI~ANSMlSSION
CITY OF YELM
P.O BOX 479 - 931 NP ROAD NE
YELM, WA 98597
360-458-8411
FAX 360-458-8166
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From: RANoY
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COMMENTS.
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** If you do llotl'CCelve all copIes or any copy IS not legIble, please call (360) 458-8411
as soun as pOSSIble.
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CITY OF YELM INSPECTION LOG
PROJECT
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WALL
o 6"
)6"'8 "
o other
/0
Date
Comments
~
Comments
o Other
J PYA
OTHER
FJNAL
A5 Sewer Fmal 4 ElectrIcal
,Yl' Address ~ InsulatIOn
o CIvIl Fmal 0 Landscape Fmal /C of 0
o SIte Dramage 0 SIdewalk
PERMIT NUMBER
6Y- t)IY~
ADDRESS
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SET BACKS Date
Front
Rear
S I de/Flankmg
SIde
FOOTING
2,.0 0 12"
L/ 't )2(16"
I f) 0 other
(,rI 0 reqUIred vents
I Dale W-- WALL REBAR
FOOTING REBAR
COMBINED FRAME/ EXTERIOR SHEAR WALL INSPECTION
Hold downs 0 ~J .~ Shear Nallmg ['
Frame 0 Gas/Propane
Plumbmg y{L~ . ir2- 11 MeChamCal)r;
INSULATION
~ Gas
/ Foam and Seal
o Electnc
o Vapor barner
Cnmments ~, !I)~
SHEET ROCK/SHEAR WALL NAIL
~teI1~
Comments
Comments
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-04-0196-YL
Issue Date 12f29f2004
(Work must be started within 180 days)
Receipt No
34343
Applic:ant:
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Name Evergreen State Builders
Phone.
253-475-6622
Address POBox 39753
City' Lakewood
State WA Zip 98499
Property Information
Site Address. 15807 104th Ave SE
Assessor Parcel No 85840006700
Subdivision Yelm T!lrra
Lot: 67
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: 1528/2, Lot 67
Sq Ft. per floor' (1 st) 788 (2nd) 740 (3rd) 0 Garage 375 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 1,04185 993.75 4810 5 6000 8 5900 $1,000
Building Plan Review 677.20 0.00 000 o 0000 o 0000
Mechanical Permit 78,25 000 000 o 0000 o 0000
Plumbing Permit 12500 2000 105 00 7 0000 15 0000 Fixture
Sewer ERU 5,269 00 000 5,26900 5,2690000 1 0000 ERU
Sewer Inspection 145 00 000 145 00 145 0000 1 0000 ERU
Water ERU 1,50000 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 75750 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 $9,988.30
Applicant's Affa,davit:
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.
Signature~~ Date /2. -Z?-O;/,
Firm
. . OFFICIAL USE ONLY
# Sets of Prints
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4 7\0 6);2)
Permit Fees Schedule
City ofVelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: Evergreen State Builders
Address. POBox 39753
Project InfoP1l3tion
Project: Yelm Terra
Description of Work: 1528/2, Lot 67
Site Address, 15807 104th Ave SE
Fees
Item Acct Code
Building Permit100-500k 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 805412-343-80-00
Water ERU 712401-343-80-01
Water Meter (SFD) 712401-343-80-01
Water Deposit 740402-389-00-00
Traffic Facilities Charge 420120-344-85-00
Sewer Deposit 742402-389-01-00
State Building Fee 160001-386-00-00
TOTAL FEES
Permit No BLD-04-0196-YL
Phone:
253-475-6622
City' Lakewood
State' WA Zip 98499
Assessor Parcel No 85840006700
Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
-------------
1,04185 993 75 4810 5.6000 8 5900 $1,000
677.20 0.00 0.00 o 0000 o 0000
78.25 000 000 o 0000 0.0000
125 00 2000 1 05 00 7 0000 15 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 00 000 1,500 00 1,5000000 1 0000 ERU
300 00 300 00 000 o 0000 o 0000
40.00 4000 0.00 o 0000 0.0000
757 50 000 757 50 7500000 1 0100 Peak PM Trip
5000 5000 000 o 0000 o 0000
450 450 000 o 0000 o 0000
$9,988.30
RECEIPT No 3 4 '34 '3
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~UND~ED EIG~TY EIG~T DOLL~~S << 30 CENTS
REf NO
PENDING
DAlE REC, NO
12/29/04 34343
AMOUN\
9,988.30 caECK
RECENED fROM
EVE~G~EEN ST~TE llUILDE~S
pO BOS 39153
LAKE~OOn, WA 98499
SITE' 15B01 104T~ ~VE LOT 61
KISCELL~NEOUS ~ECEIPT
1)1~N~ ~..-'
KEc~~~~~;iRU~S/INSP145
T~~rr1S1.50. S/1)EPS0. STrEE4,50
llLDP~KT1041.B5. PLN~EV611.Z0,
N/E~U1S00. N/KT~300. N/1)EP40.
RECEIPT NO, 343440
rou~TEEN 1)OLL~~s << 10 CENTS
BEf NO
PENDING
DAlE
12/29/04
BEC NO
34344
AMOUNI
10,014.10 caECK
BECENEO fROM
EVE~G~EEN ST~TE llUIL1)E~S
pO B01 39153
LAKEWOOn. WA 98499
SITE. 151114 104TK LOT41
KISCELL~NEOUS ~ECEIPT
DI~N~ ~
KECKP~KT11.15. PLKllP~KT111. S/~. S/INSP1
TR~rr1S1.50. S/1)EPS0. STrEE4.50
llL1)P~KT1069.91. PLN~EV695.44.
N/E~U1500. N/KT~300. N/1)EP40.
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YELM COMMUNITY SCHOOLS
I LOCAL RECIEIPT DATE 1.1 - 2 ~
yf~<..1
25472
Receivedfrom ~v(.r~f"ee'" S+-....~< 1)"Jcl.Lrs L-c...c.
FOR ~/ ,., --r; Ira... ;f4. (./ ..,,,.J.,,,.J L~ t- ':s 6 7} t( 7
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ACCOUNT CODE
AMOUNT CASH CHECK
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CITY OF YELM
RESIDENTIAL BUilDING PERMIT APPUCATION FORM
Project Address: L C+ Parcel #.
Subdivision. '\~\W\-T~(,t'A Lot#. &1 Zoning; ~'^'6.' ~\lv\
flNew 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.. S 'f'- ~ \ ~f\W'\. \1. u '\ de.-V\.--t 41\-1
projectValue~ IcFI,900. a>
Building Area (sq. ft) 1st Floor lBca 2nd Floor(L-tb Garage ~) S Deck 1---
Basement "'f' Carport -+ Patio "'Z.\ b
# Bedrooms::L # Bathrooms~ Heating' @THER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? NO If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER NAME "\'l~teeYl c;;;:-\-.t'ct;--e ~\\d t.f"~ 1-. L. L
ADDRESS:t815 J{)(;yfrJ $-7 >. LJ. ~utt-e. 2.ft EMAIL '
CITY L.l\1tewo(t~ STATE vJ ft ZIP'; 8..... ~ 1 TELEPHONE 2-530- 1175- 66 Z 2
GENERAL,QQN"fRAQTQR ~~~ 1)-5> Qwl/\e.... TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # ~u~asb &J80 fbEXP DA TE~ITY LICENSE #
\\:k TELEPHONE 2....6~- .:531- '100
EMAIL
ZIP7Prf'iS FAX ~'5.3-:.536- Of f.~b
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
f hereby certify that the above irtformation is corJll(: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.
~ lH/;-CJt.)
plica ' Signature Date ' ,
Owner I Contractor ~~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 of180 days
105 Yelm Avenue West
PO Box 479
Yelm, WA 98597
(3GO) 458-3835
(3GO) 458-.'/144 FAX
llIllIw.ci.yelm.wa.U8
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Evergreen State Builders LLC (License # EVERGSB980PB)
5100 -100"1 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 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 elevatiOn per plan.
Roofing:
Architectural ComposItion roof.
Windows:
Vinyl windows to code and as per plan.
Driveway:
Broom fimsh.
PatiolWaikways:
Broom finish..
Cabinets:
Oak cabinets, flush paneL
Embossed pack'1e.
Insulated steel, 0' fiberglass.
Embossed pack~e.
Stool and Apron hnlY
Doors:
Exterior:
Millwork:
Window Wrap:
Plumbing:
Kitchen Sink: 33x22, 3- ole, double-sink. Stainless with chrome delta faucet
Lavatory:
QI Powder Roo i. white WIth Delta. chrome faucet.
e Hall Bath,,- Ki gore whIte sink with Delta chrome faucet.
lit Master Bath, (2) 20x] 7 white with Delta chrome faucets.
0) Tub V alve,~~r bath. Delta chrome or eqmvalent.
lIlI Tub/Shower Valve, Main path: Delta tub and shower valve.
.. Shower ValvJ. Master: Delta or eqUIvalent.
.. T oUets. whit , per plan.
...1
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 glass door on separate shower Wlth chrome trim.
Tubs: Fiberglass whIte.
Gas 50 gallon.
Two per plan.
Locks interIor:, Chrome
J."ocks exterior: Chrome
Towel bars. Chrome
Paper holders: Chrome
C~et: Dming room, living room, stairs, bedrooms, closets, 6 lb., 1/2"
rcbond pad.
Vinyl: Utility ro()m, han bath and Entry
Laminate. Whole house
Exterior Trim: \Vhlte or color from approved lIst.
Exterior Body:. Flat solid body paint from approved list.
Front Door: 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. Wlllrlpool whIte.
Dishwasher: Whirlpool Self Clean, WhIte.
DISposal: 1/2 HP.
Icemaker: Refrigerator space plumbed for icemaker.
Microwave. Whirlpool whIte
Phone (2) cable (2)
]llage two of two