20040190
CITY OF YELM - BUILDING DEPARTMENT
RESIDENTIAL CERTIFICATE OF OCCUPANCY
Building Address
15850 104th Ave SE
Everqreen State Builders
P.O. Box 39753
Lakewood. WA 98439-0753
Owner Name
Owner Address
Building Permit Number
BD-O 190- YL
Plan Number'
2211/2
Remarks
Areas Inspected
All Code Required
Special Conditions
None
Building Official
Garv Carlson
Date
Mav 4. 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
PERMIT NUMBER
CITY OF YELM INSPECTION LOG
~
y~ 1~lY'c- ;; 211
/
(; t/ ~ t:>' f 0
W5~
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PROJECT
ADDRESS
/SBSD It/If Lt.- A ~ S€
~T BACKS Date
\~ Front ~ 0
.~ ~ Rear ~$1
~\.\ \~ \' Slde/Flankmg
~/ \'V\ SIde
FOOTING
WALL
o 6"
)1 8"
o other
IV fP'--- -)IJ~
D 12"
B 16"
7 0 other
-
.5 D reqUlred vents
~ Date. WALL REBAR
FOOTING REBAR
Date
Comments
c
COMBINED FRAME/ EXTERIOR SHEAR WALL INSPECTION
Hold downs 0 Shear Nadmg 0
Frame ~~ ' Gas/Propane 0
Plumbmg. ')', 1 t) Mechamcal 0
~ L L
Comments 5"t" , -Kli"w.. ,....~ i ~4ct \ j\~ piPlI .)Il'-V
INSULA TION
o Gas
o Foam and Seal
D Electnc
o Vapor barner
o Other
o PYA
Comments
SHEET ROCK/SHEAR WALL NAIL
Comments
OTHER
Comments
FpfAL
P Sewer Final f)lectncal
y Address 7InsulatlOn
Comments vhv 61~
o CIvd Fmal 0 Landscape Fmal 0 C of 0
D SIte Dramage 0 SIdewalk
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FROM YELM SEWER DEPT
FAX NO 360-458-8166
Ma~. 02 2005 01 18PM Pi
FAX TRANSMISSION
CITY OF YELM
.0. BOX 479 - 931 NP ROAD NE
Y1EL~, VVA 98597
0-458-8411
E X 360-458-8166
DATE: ~-~ ~ - ac;-
PAGES: 1 , including this
Cover sheet
Fron1: Rf1,(jDt.(
Subject: Ho ~'SE:: ~ ('{\1 A L-
'-1 E" (... W\ \'€''- <<J1
COMMENTS. l-oT 531 1~<('<Jo lo"l\!! AuE"", S.E.
OS-5S30.00
** If you do not receive all coples or any copy is not legible, please call (360) 458-8411
as soon as possible.
/"
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b}id
CIty ofYelm - Buildmg Department
CORRECTION NOTICE
a
b}id
I have thIS day inspected thIS structure and these premIses
and have found the following violations of the CIty of Yelm
and/or State laws governing same:
PERMIT NO. 6 t.{.- 01 q V
L-uJ-s-~
~ e1 /b-~ ~euJ 1/.5 1:eoi-
f/lLil ,.;~ A-15 (8 i D ~0
') J 1-OfWY" ~ ~ o--t.2- C<Jf'.J.rft.( { !'0 ~ I- fJ- t ~ f l/v &,
You are hereby notified that no more work shall be covered upon these premO
corrected. When corrections have been made, call for re-inspection at 458-8 7
DO NOT REMOVE THIS TAG DATE C) 1/ I J lOr
above violations are
Yelm School District
ATTN SUSAN CROY
PO BOX 476
YELM, ~jA 98597
360-458-1900
Sold to 16755
EVERGREEN STATE BUILDERS LLC
56622
BUILDERS LLC EVERGREEN STATE
5516 75TH ST W ~1
LAKEWOOD, WA 98499
II 5606 10 12/02/04
Reg 111 SalesPerson SUSAN
Item II 2900/MITIGATION
MITIGATION OR TVF
i .~ i,7ii 00 1,711 UO
CK 115202 FOR LOT 51 OF YElM TERRA DEVElO
PMENT
Item II 2900/MITIGATION
MITIGATION OR TVF
1 @ 1, 711 00 1 , 711 00
CK 115202 FOR LOT 53 OF YELM TERRA DEVElO
PMENT
ltem II 2900/MITIGATION
MITIGATION OR TVF
1 @ 1, 711 00 1 , 711. 00
CK 115202 FOR LOT 55 FOR YELM TERRA DEVEl
OPMENT
Item II 2900/MITIGATION
MITIGATION OR TVF
1 @ 1,71100 1,71100
CK 115202 FOR LOT 66 FOR YELM TERRA DEVEL
OPMENT
SubTotal
6,844 00
Total Due
Check
6,844 00
6,844 00
----------
----------
Thank you
PLEASE KEEP THIS RECEIPTI I I
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City ofYelm
Community Development Department
Building Division
Phone. (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-04-0190-YL
Issue Date. 11/23/2004
(Work must be started within 180 days)
Receipt No
34117
Applicant:
Name Evergreen State Builders
Phone
253-475-6622
Address POBox 39753
City' Lakewood
State W A Zip 98499
Propertylnformatibn
Site Address. 15850 104th Ave SE
Assessor Parcel No 85840005300
Subdivision: Yelm Terra
Lot: 53
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 2211/2, Lot 53
Sq. Ft. per floor (1st) 1071 (2nd) 1140 (3rd) 0 Garage 434 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 1,299 32 993.75 305 57 5 6000 54 5660 $1,000
Building Plan Review 844 55 000 000 o 0000 o 0000
Mechanical Permit 78.75 000 000 o 0000 o 0000
Plumbing Permit 125 00 2000 1 05 00 7 0000 15 0000 Fixture
Sewer ERU 5,26900 0.00 5,26900 5,269 0000 1 0000 ERU
Sewer Inspection 14500 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 000 o 0000 o 0000
Traffic Facilities Charge 757 50 000 757 50 7500000 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 $10,413.62
Applicant's Affaqavit:
---
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 /) Washington
Signature .L.h"--:7~. Date ,//-Z.j?'-d e-./
Firm_Z 5" ,;5_
# Sets of Prints
---
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Permit Fees Schedule
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applic:allt: ..
Name. Evergreen State Builders
Address POBox 39753
Project Information
Project: Yelm Terra
Description of Work: Plan 2211/2, Lot 53
Site Address. 15850 104th Ave SE
Fees
Item Acct Code
Building Permit 100-500k 032001-322-10-00
Building Plan Review 100 001-345-83-00
Mechanical Permit 032001-322-10-00
Plumbing Permit 032001-322-10-00
Sewer ERU 802 412-343-50-01
Sewer Inspection 805 412-343-80-00
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-04-0190-YL
Phone:
253-475-6622
City' Lakewood
State WA Zip 98499
Assessor Parcel No 85840005300
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
-------------
1,29932 99375 305 57 5 6000 54 5660 $1,000
844 55 000 000 o 0000 o 0000
78.75 000 0.00 0.0000 o 0000
125 00 2000 105 00 7 0000 15 0000 Fixture
5,26900 000 5,269 00 5,269 0000 1 0000 ERU
145 00 000 145 00 145 0000 1 0000 ERU
1,500 00 000 1,50000 1,5000000 1 0000 ERU
300 00 300 00 000 0.0000 o 0000
4000 4000 000 o 0000 o 0000
757 50 000 757 50 7500000 1 0100 Peak PM Trip
5000 5000 000 o 0000 o 0000
4.50 4.50 000 o 0000 o 0000
$10,413.62
DlD
Net ~ o/.-
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--
~~./fi CITY OF
I~"r \;;, , YELl\.1
~; ,- . i'
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btd~. ,t~~ ~~x t;~-
- - - - r. r".....,...
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14 \ -. 5
RECEIPT tJo .) 1 l.
--,....~I ,-~
r ::.,--t:. \ ="l-~ * * NINE THOUSAND EIGHT HUNDRED NINETY DOLLARS & 41 CENTS
=.=:.=!~== ~~..:;f\"
':;LTE ::::c tiJ
EVERGREEN STATE BUILDERS
PO BOX 197
LAKE WOOD WA 98499
11/23/04 34116
9.890.41 CHECK
PENDING
SITE: 15813 104TH AVE SE LPT66
'-
MISCELLANEOUS RECEIPT
DIANA
--_.-
BLDPRMT1149.15. PLNREV485.51. MECHPRMT78.75. PLMBPRMT111. S/ERU5269. SINSP145
W/ERU1500. W/MTR300. W/DEP40. TRAF757.50. S/DEP50. STFEE4.50
I~ l ~ 0{ . I. .J!!:\-. ~ -<=~ :'~~ ~~Trj~~~~T0l:t;~~~~t~la~~~~~~i~~~~~~.~~~~~f1~~1
S~;:::-'_--l
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PEe E.!PT No
:1 /. ~ 1 7
-..1 '+ 1 .... !
:S~_-~:': t.'-+'-..:'
C'::.'-~!\ C"!-
, -".... ..nrEN THOUSAND FOUR HUNDRED THIRTEEN DOLLARS & 62 CENTS
---- -- ---
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~._I~
: I _~ _
""',1\ '- _
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD. WA 98499
SITE: 15850 104TH AVE
/\
S'E L.OT53
~.
11/23/04 34117
10.413.62 CHECK
PENDING
SCELLANEOUS RECEIPT
ANA
BLDPRMT 1299.32. PLNREV84. . MECHPRMT78.75. PLMBPRMT125. S/ERU5269. SINSP145
W/ERU1500. W/MTR300. W/DEP40. TRAFF757.50. W/DEP50. STFEE4.50
~~~J'fr4i~~~.~~~1r:j~~~1-a~~t=J~;~~t~Jf'~~~~Jrllilf!~iij~~~~~~~?~?~~FGr-1:T;~~~~'7~f.o;~~~~~~~i~\1.~f;?;~{,~;~,~~~}~~.~-"
~~g~~'\rlv.:!fP:~~~~..?~f$;r.:t"N'-,~~,.'R:.~;~"" '. ~~}.."..,....~,1!u.~~..:.f-.~~~ _ . .iJ"~ _ _~.~~:n+u~~~~ill~~_'''~'''''--~.t~,,~_~--:;~\$.~,,~4'?7;}~,,~1\/'i'J~*_ .~,'*~~~:~hr~tlf~
I%~~CIT\ OF
j},-, ",\1 ""\.,'ELl\,!"l
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. - * * · *"'!'EN THOUSAND FORTY EIGHT DOLLARS & 73 CENTS
-- -.-----
- - .....' '-.... i.'
-~- --- _.
"-.=-- -.:
~:\ - -
EVERGREEN STATE
PO BOX 197
LAKE WOOD WA
SITE: 15838
BUILDERS
11/23/04 34118
10.048.73 CHECK
PENDING
98499
104TH AVE SE LOT51
'--
MISCELLANEOUS RECEIPT
DIANA
BLDPRMT1090.90. PLNREV709.08. MECHPRMT71.75. PLMBPRMT111. S/ERU5269. S/INSP145
W/ERU1500. W/HTR300. W/DEP40. TRAFF757.50. S/DEP50. STFEE4.50
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name Evergreen State Builders
Address. POBox 39753
Project Information.
Project: Yelm Terra < ~
Description of Work: Plan 1740B/2, L~
Site Address. 15850 104th Ave SE
Fees.
Item
Acct Code
Building Permit 100-500k 032001-322-10-00
Building Plan Review 100001-345-83-00
Mechanical Permit 032001-322-10-00
Plumbing Permit 032 001-322-10-00
Sewer ERU 802 412-343-50-01
Sewer Inspection 805 412-343-80-00
Water ERU 712 401-343-80-01
Water Meter (SFD) 712401-343-80-01
Water Deposit 740402-389-00-00
Traffic Facilities Charge 420 120-344-85-00
Sewer Deposit 742402-389-01-00
State Building Fee 160 001-386-00-00
TOTAL FEES
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Permit Fees Schedule
PAID
NOV 2 3 2004
CITY OF YELM
City' Lakewood
Phone.
Permit No BLD-04-0190-YL
31/1/7
State WA Zip 98499
253-475-6622
Assessor Parcel No 85840005300
Item Fee Base Amt
1,29932 993 75
844.55 000
78.75 000
125 00 2000
5,269 00 000
145 00 000
1,50000 000
300 00 300 00
4000 4000
75750 000
5000 5000
450 450
$10,413.62
305 57
Unit Rate No Units Unit Desc
Unit Fee
000
56000 54.5660 $1,000
o 0000 0 0000
1 05 00
7 0000
0.0000 0 0000
000
5,269 00 5,269 0000
14500 1450000
1,50000 1,500 0000
000 o 0000
000 o 0000
757 50 7500000
000 o 0000
000 o 0000
15 0000 Fixture
1 0000 ERU
1 0000 ERU
1 0000 ERU
o 0000
o 0000
1 0100 Peak PM Trip
o 0000
o 0000
ll/esnael\ '1'1: 3~
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YELM TERRA
YELMi WA
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPUCATION FORM
Project Address 1.. C+ ..5 ~ Parcel #.
Subdivision '\'l\W\-T.~:(,'t'f\ lot#. r6~ Zoning; <;;'''\9)\ ~IN\
.ffNew 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. '5 \f'\ ~ \ ~t\W'. \l ~ \ Ol."'-"'" 4 pt-\
Project Value _~JI21 6.Si ,co Go.sA 'TD Zo"ls.-tnJ~f
Building Area (sq. ft) 1st FloorLo"?) 2nd Floor W..lO Garage ~-r~ ~ Deck-
Basement - Carport Patio 2..1 b
# Bedrooms~ # Bathrooms~l2.. Heating~OTHER 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.
BUILDING QWNERNAME ~\)~tee'1 ~~ltte ~\\dtf"~ t...L. f..,
ADDRESS"'3-8/5 jO(;)'~ S-T s., Wi ~\.Ht-e "Lit EMAIL I
CITY L. f\"Kewoo\O STATE uJ It ZIP~ 8<-t ~ ~ TELEPHONE 2,5?>-L-i 75- 66 Z 2
ARCHITECT/ENGINEER c.l\:t.~(.:)e {es:.\'~e LICENSE #
ADDRESS 102 S:.. 7-(, .s: ('c [EMAIL ").5"3- 2-8L/- ~nD
CITY ('A-(:.dlh\ t\- STATE '-^-'Jt ZIP ~~o).. \:fELEPHONE cJt~c.~e @.!.)(. fJ~.L
GENERAlCONTRACTOR ~~e.. i')-~ owll\t(" TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # FU~3Sb ')80 fl:>EXP DA TE~ITY LICENSE #
PLUMBING CONTRACTOR et ~"'\ tJ-'UT TELEPHONE ~5~- ~3'1- r '7[]'
ADDRESS !8.lA CrYil-J ~ \ . EMAIL
CITY~_STATE t..J4- ZIP7PrNS FAX 2...'5~-:5.36- 9 t.6( =
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRAGTOR
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 propert will be in accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
/1-} I-Oc!
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 of180 days
105 Yelm Avenue West
PO Box 479
Yelm, W,4 98597
-
(360) 458-38.~5
(360) 458-3144 FAX
www.ci.;yelm.wa.lI.S
tJ.
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Evergreen State Builders LLC (License # IEVERGSB980PB)
5700 _100th Street S,W , ,Suite 630, Box 197, Lakewood, WA 98499
253-475-6622 (Fax 253-4:'5-6127)
DESCRIPTlor~ OF MATERIALS fOf'
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 shakJes or shake panels as accents
flont elevatIon per plan.
Roofing:
Architectural ComposItion roof.
Windows:
Vinyl windows to code and as per plan.
. '~~,
Driveway:
Broom fimsh.
PatiolW allkways:
Broom finish.
Cabinets:
Oak cabmets, flush panel.
Doors:
Embossed package.
Exterior:
iIlsulated steel, or fiberglass.
Millwork:
EJ?1bossed package.
Stool and Apron only
Window Wrap:
Plumbing:
Kitchen Sink: 33x22, 3-hole, double-sink. St.ainless with chrome delta faucet.
l,avato:ry:
It Powder 13.00111. whIte WIth Delta chrome faucet.
.. Hall Bath-,- Kilgore white sink with Delta chrome faucet.
.. Master B:!!h: (2) 20x17 wlute WIth Delta chrome faucets.
. Tub V aly~Master bath. Delta chrome or eqUlvalent.
. Tub/Shower V rove, Main bath: Delta tub and shower valve
. Shower VJ!!ve, Master: Delta or eqUlvalent.
e' Toilets. white, per plan.
~
Bath enclosures:
Hot Water Tank:
Hosebib:
Hardwarl~:
Bath hardware:
Flooring:
Countertops:
Pai.nting:
Appliances:
Wiring:
. ~'
\0
(\
"'-~
Page one of two
l\'laster bath: Clear glass door on separate shower with chrome tnm.
Tubs: Fiberglass whIte.
Gas 50 gallon.
Two per plan"
Locks interior: Chrome
Locks exterior: Chrome
Towel bars. Chrome
P,aper holders: Chrome
.c~ Dmmg room, livmg room, stall'S, bedrooms, closets, 6 lb., 1/2"
r~~bond pad.
Y:inyl: Utlhty room, hall bath and Entry
taminatec Whole house
Extenor Trim: WhIte or color from approved lIst.
ExterIor Body: Flat solId body pamt from approved hst.
Front Door~ Enamel, whIte or accent color from approved lIst.
Iriterior Walls. Drywall sealer coat, then one coat flat latex.
Kltchen and bathrooms. Low sheen enameL
Range/Oven. .WhIrlpool whIte
tHshwasher: \Vhirlpool Self Clean, White:
Disposal. 1/2 HP
kemaker: Refrigerator space plumbed for lcemaker.
~.1icrowave: W'hirlpool whIte
Phone (2) cable (2)
Page two of two