20040195
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crN Of 'fELNI- BUILOING oEP AR1N1ENl
RESIOEN11AL CER1\f\CA1E Of OccUPANC'f
eui\din9 flo.ddress
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eui\d\n9 permit Number
p\an Number
owner Name
owner flo.ddress
flo.reas \nspected
specia\ cond'ltions
None
oate
June" 1 2005
RemarKs
----
p..\\ Code ReQuired
eUi\d\n90<<iciat
. . \ tern.lion.1 Residenti.1 Code (ChOPtel
1~is structu,e'lS in compll.nce ~lt~:e t St.te Building Code council pUISU.nt
5,,-5" Wflo.C) as adopted b'jt 2h1ea dS10'"~2o~C\N effeclive JUW 1.200'
to Chapters" 9 an '
G. car\Son
FROM YELM SEWER DEPT
FAX NO. 360-458-B166
Jun 16 2005 03 30PM P1
FAX TRANSMISSION'
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TO:
CITY OF YELM
P.O. BOX 479 - 931 NP ROAD NE
YELM, W A 9,3597
360-458-84 11
FAX 360M458-8166
DATE: ~ (b-O~-
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PAGES: I , including this
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From: RAJVOY
Subject: HDlr\S E" f,A.)A~ / ~["Lm ~\2.A
COMMENTS L oT ~ ~ I '5'"~b) ) OqJjJ Av~ . S, E I
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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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I M p.., U Building Address 15801 1041h Ave. SE
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I r- I:Ll ..-f ~ Owner Name EverQreen Stale Builders
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:::> I - >- ~ Owner Address P,O. Box 39753
....., Z U) I ~ Lakewood. WA 98439-0753
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E-i II I Building Permit Number BLD-04-0195- YL Plan Number 1819/02
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~ E-i Remarks:
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~ 5 r- >- Date: June 17, 2005
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~ E-l r-l ~ This structure is in compliance with the International Residential Code (Chapter
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~ 51-51 WAC) as adopted by the Washington Slate Building Code Council pursuant
I ~ 10 Chapters 19,27 and 70,92 RCW effective July I, 2004
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-04-0195-YL
Issue Date 12/07/2004
(Work must be started within 180 days)
Receipt No
34222
Applicant:
Name, Evergreen State Builders
Phone,
253-475-6622
Address POBox 39753
City' Lakewood
State, WA Zip 98499
Property Information
Site Address 15801104th Ave SE
Assessor Parcel No 85840006800
Subdivision: Yelm Terra
Lot: 68
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: 1819/02, Lot 68
Sq Ft, per floor' (1st) 1363
(2nd) 658
(3rd) 0
Garage 440
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 1,229 14 993 75 235 39 5 6000 42,0340 $1,000
Building Plan Review 798.94 000 000 o 0000 o 0000
Mechanical Permit 8475 000 000 o 0000 o 0000
Plumbing Permit 132.00 2000 112,00 7 0000 16 0000 Fixture
Sewer ERU 5,26900 000 5,269 00 5,2690000 1 0000 ERU
Sewer Inspection 145 00 000 145 00 145 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 0.00 757 50 750 0000 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 $10,310.83
Applicant's Affada"it:
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 Washi gton~ ~
Signature ~ Date ,-z. - - 0 c.f
OFFICIAL USE ONLY
# Sets of Prints
Final Inspection
Date,
Firm
By'
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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
CK #8954 FOR LOT 61
Item ~ 2900/MITIGATION
MITIGATION OR TVF
1 @ 1,71100
CK #8954 FOR LOT 63
Item # 2900/MITIGATION
MITIGATI~~
____1 @ 1,711.0'0
~~K #8954 FOR LOT 68
Item # 2900/MITIGATION
MITIGATION OR TVF
1 @ 1,711 00
CK #8954 FOR LOT 48
Item # 2900/MITIGATION
MITIGATION OR TVF
1 @ 1 ,711. 00
CK #8954 FOR LOT 50
SubTotal
Total Due
Check
1 ,711 00
1 , 711. 00
1 , 711. 00
1,711 00
1 , 711 .00
8,555.00
8,555.00
8,555.00
----------
----------
Thank you.
PLEASE KEEP THIS RECEIPT! \ \
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RECEIPT No .... 4,- c.. .....
.~ -= -!:: fcr.
-Hi. ..nrEN THOUSAND ONE HUNDRED FORTY DOLLARS & 97 CENTS
~;=-.=~ :=~.. =~,- i,:;
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EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD WA 98499
12/07/04 34221
10,140.97 CHECK
PENDING
SITE: 15843 104TH AVE SE L63
MISCELLANEOUS RECEIPT
DIANA
BLDGPRMT1138.62, PLNREV740.10, MECHPRMT78.25, PLMBPRMT118, S/ERU5269, S/INS145
W/ERU1500, W/MTR300, W/DEP40, TRAFF757.50, S/DEP50, ST FEE4.50
~~ff.~~2i-~~!;1~~~1~~];r~~~~~!~J;~~1~:!tm~~1JZ~:;aTib~~tjil~~~~[~~)
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-***WTEN THOUSAND THREE HUNDRED TEN DOLLARS & 83 CENTS
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EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD WA 98499
12/07/04 34222
10,310.83 CHECK
PENDING
SITE: 15801 104TH
-......
RECEIPT
L68
BLDGPRMT1229.14, PL V798. ECHPRMT84.75, PLMBPRMT132, S/ERU5269, S/INS145
W/ERU1500. W/MTR300, W/DEP40, TRAFF757.50, S/DEP50, STFEE4.50
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CITY OF YElM
RESIDENTIAL BUilDING PERMIT APPUCATION FORM
Project Address 1... C+ 6~ Parcel #.
Subdivision. '\ ~\ W\ -\'~ (,t'l\ lot #' 4.~ Zoning; s;: V\~, ~\M
2:f"New Construction 0 Re-Mode! / Re-Roof / Addition 0 Home Occupation Sign
o Plumbing 0 Mechanical 0 Mobile I Manufactured Home Placement 0 Other
Project Description/Scope of Work. '5 'f'\ ~ \ ~i\"'" \1. <u. \ de.-V\..--t .""'\
A l ~ c... to
Project Value. , \ ~ f ,,~ 'j,
Building Area (sq. ft) 1st Floor l~l.~ 2nd Floor ~ Garage ~ Deck 'f-
Basement 'f carporri: Patio ""L...\.(,
# BedroomsS # Bathroorr~JZ- Heating:@THER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? Va If yes, a
completed environmental checklist must accompany permit application.
\
BUILDING OWNER NAME ~\l ~te:eY1 1;.-\ tct'e ~\ \d tf"s, L.. L. (,
ADORESS~8/5 )()(;r~ S.T $..r:...Ji 40tt-€.2.1t EMAIL .,
CITY L.l\itewOO\() STATE vJft zIP~8<-i<1~ TELEPHONE 2-5?>-t..t7S- 6.6Z2.
ARCHITECT/E.NGINEER c.1\:L '(.:Ie. ~\"&e LICENSE #
ADDRESS 102. S:, "2-6 ~ rc- e:EMAIL -;.53- 2.8 ~- '"3..f10
CITY cl\-(.O'V\ "'t STATE uJ,4t ZIP '7~(J).. \.:FELEPHONE (fTS..c.~e ~t.)(., tJeI-r.a-n,[
GEJ\jERALQON-rFAA:CTOR ~~e.. ~~ C~"'e.(' TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # ~ve("OS~ &jBO f'bEXP DA TE~ITY LICENSE #
kPr TELEPHONE 2....5":>-.53>,- '700
EMAIL
ZIP'7Pf-fY S- FAX 2..5.:0--536- 9 fdo{,
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
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.
~
plica Signature ('_ Date
Owner J Contractor ~er'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 ofiS0 days
(3GO) 458-3835
(3GO) 458-3144 f'AX
www.ci.yelm.wa.UB
105 Yelm Avenue West
POBox 479
Yelm, WA 9859'1
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Evergreen State Builders LLC (License # EVERGSB980PB)
5700 -100th 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 wall
sidmg sIdes and back; James Hardie shakes or shake panels as accents
front elevation per plan.
Roofing:
Architectural CompOSItion roof.
Windows:
Vinyl wmdows to code and as per plan.
Driveway:
Broom finish.
PatiolWalkways:
Broom finish.
Cabinets:
Oak cabmets, flush paneL
Doors:
Embossed packa e,
Exterior:
Insulated steel, 0 fiberglass.
Millwork:
Embossed pack e.
I
Stool and Apron only
Window Wrap:
Plumbing:
Kitchen Sink: 33x22, 3- ole, double-sink. Stainless with chrome delta faucet.
Lavatory:
· Powder Roo . whIte with Delta chrome faucet
It Hall Bath. Ki gore white sink with Delta chrome faucet.
. Master Bat!1. (2) 20x 17 white with Delta chrome faucets.
.. Tub Valve, aster bath. Delta chrome or eqmvalent.
. Tub/Shower alve Main bath: Delta tub and shower valve.
\VI Shower Valv ,Master: Delta or equivalent
· Toilets, Wlnl per plan,
Bath enclosures:
Hot Water Tank:
Hosebib:
Hardware:
Bath hardware:
Flooring:
Countertops:
Painting:
Appliances:
Wiring:
o
o
Page one of two
Master bath: Clear glass door on separate shower with chrome tom.
Tubs: Fiberglass white.
Gas 50 gaUon.
Two per plan.
Locks interior:, Chrome
Locks exterior: Chrome
Towel bars~ Chrome
Paper holders. Chrome
C!;1I'pet: Dining room, livmg room, stairs, bedrooms, closets; 6 lb., 1/2"
rebond pad.
Vinyl: Utility room, han bath and Entry
Lammate: 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.
Intenor Walls. Drywall sealer coat, then one coat flat latex.
Kitchen and ballm;>Olns: Low sheen enamel.
Range/Oven. Whirlpool whlte.
Dishwasher: Whirlpool Self Clean, Whlte.
DISposal: 1/2 HP
Icemaker: Refrigerator space plumbed for icemaker.
Microwave. Whirlpool whIte
Phone (2) cabh:: (2)
])age two of two