20040185
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CI\'l Of 'fELt.II- BUILOI",G OEP />..R1t.11E"'1
RESIOE"'11/>..L CER1IfIC/>..1E Of OCCUP />..",C'f
euilding f\ddress
~58'38104\\1 p..,'Je. SE..
~s~
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~W~5'3
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Plan Number
~6~Q~
euilding permit Number
p..,\\ Code Reauired
~
owner Name
owner p.ddress
Rem ar\<.5'
I\{eas \nsgected'
Sgecial conditions
None
oate
euilding O<<iciat
. . I lero.\loo.1 Resideoll.1 code (C\l.~ter
1\11S strUClure Is 10 coo\PllOoce :t~~~: I~O stale Buildl09 Code couocil ~ursu'OI
5~-5~ wp.C) as ad09ted b'lt 2"7e da 70 ~2 RC'i'J effec".e JUW \.2004
\0 c"a9\ers ~9. an '
G. carlson
,~
FROM YELM SEWER DEPT
FAX NO. 360-458-B166
Apr 29 2005 02 5iPM Pi
FAX TRANSMISSION
~~~~
TO: &r~ -- -c.I-ICfIJ
CITY OF YELM
P.O. BOX479-931 NP ROADNE
YELM, W A 98597
360-458-8411
Fix 360-458-8166
DA TE: LJ ~ d ()~. () ~..-
FAX#:
PAGES-
, including this
Cover sheet
From: CK(-)AJOY
Subject: H- D U rs~ )=:: \ f\J)1 "-
COMMENTS. LoT ~) I 1 '5~ 3Y:. I 6q-n-l A\J~. ~ L .
J
tf5 - '551b .00 J
** If you do not receive all copies 01' any copy is not legible, p'~ase call (360) 458-8411
as soon as possIble
'I,
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CITY OF YELM INSPECTION LOG
PROJECT
t"f 51
---
'1~,-~ J e.e.eA-
PERMIT NUMBER 0 l/ - D I ~..s-
ADDRESS I ~&3~ /64 tJ;:.. A\rC Se-
/'
FOOTIN G
~ 12"
o 16"
o other
o reqUIred vents
Date. WALL REBAR
WAsy
.E'6"
o 8"
o other
)T BACKS Date
Front
Rear
~t,,\" \ n"l Slde/Flankmg
;Y (V\\-1 \ SIde
\ FOOTING REBAR
Date
Comments
c
COMBINED FRAME/ EXTERIOR SHEAR WALL INSPECTION
Hold downs ~ ~ / Shear NaIlIng D
Frame ~ I( &\ / Gas/Propane 0
Plumbmg ~ b ( MechanIcal 0
Comments
INSULA TION
o Gas
o Foam and Seal
o Electnc
o Vapor barner
o Other
o PYA
Comments
SHEET ROCK/SHEAR WALL NAIL
Comments
OTHER
Comments
FI.Pl AL
;{ ;ewer Final -2J yectncal
)y Address ft InsulatIOn
Comments -l. f Y b{
I
o CIVIl Fmal 0 Landscape Fmal 0 C of 0
o SIte Dramage 0 SIdewalk
c
o
o
City ofYelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-04-0185-YL
Issue Date 11/23/2004
(Work must be started within 180 days)
Receipt No
34118
Applicant:
Name: Evergreen State Builders
Phone.
253-475-6622
Address POBox 39753
City' Lakewood
State. WA Zip 98499
Prop~rty Informa'tiqn
Site Address. 15838 104th Ave SE
Assessor Parcel No 85840005100
Subdivision: Yelm Terra
Lot: 51
Contractor Information
Name. Evergreen State Builders
Contact: McCullem, Tom
Phone 253-475-6622
Address. POBox 197
City. Lakewood
State. WA Zip
Contractor License No EVERGSB980PB
Expires. 10/02/06275
Business License: 1042.0
Project fnfo!n1ation.
Project: Yelm Terra
Description of Work: Plan 1610 R/2B , Lot 51
Sq. Ft. per floor. (1 st) 1610
(2nd) 0
(3rd) 0
Garage 470
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 1,09090 99375 9715 5 6000 17 3490 $1,000
Building Plan Review 709 08 0.00 0.00 o 0000 o 0000
Mechanical Permit 7175 0.00 0.00 o 0000 o 0000
Plumbing Permit 111 00 20.00 9100 7 0000 13 0000 Fixture
Sewer ERU 5,269 00 000 5,26900 5,269 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
Water Deposit 4000 4000 000 o 0000 o 0000
Traffic Facilities Charge 75750 000 757 50 750.0000 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 $10,048.73
Applical1t'~ Affadi:lyit:,
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 # Sets of Prints,
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.
S. t ~/ ----- ./? ~ Date . A /- Z ?- -!' -<-/"
Ignaure ~,.._"~~~/.- //- ~ L.... /"
Firm
E -5 /'<;'
By'
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Permit Fees Schedule
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 1610 R/2B , Lot 51
Site Address 15838 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 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-04-0185-YL
Phone.
253-475-6622
City. Lakewood
State. WA Zip 98499
Assessor Parcel No 85840005100
Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
-------------
1,09090 993 75 9715 5 6000 17 3490 $1,000
709 08 000 000 o 0000 o 0000
7175 000 000 o 0000 o 0000
111 00 2000 9100 7 0000 13 0000 Fixture
5,26900 000 5,26900 5,269 0000 1 0000 ERU
145 00 000 145 00 145 0000 1 0000 ERU
1,50000 000 1,50000 1,500 0000 1 0000 ERU
300 00 300 00 000 o 0000 o 0000
4000 4000 000 o 0000 o 0000
757 50 000 757 50 750.0000 1 0100 Peak PM Trip
5000 5000 000 0.0000 o 0000
450 450 000 o 0000 o 0000
$10,048.73
'D t D 1'-t <:> I +-t--A:t-/.Ie.-
S <:.- rta C,) '-
VVl ill ~ ovu
~-t:::;-c.. eQ 'Pr
e
RECEIPT No 34116
RECEIVEn
****NINE THOUSAND EIGHT HUNDRED NINETY DOLLARS & 41 CENTS
11/23/04 34116
9,890.41 CHECK
REF NO
PENDING
RECEIVED FROM
EVERGREEN STATE BUILDERS
PO BOX 197
LAKEWOOD WA 98499
[;,.;TE REC NO
AMOUNT
SITE: 15813 104TH AVE SE LPT66
'-
MISCELLANEOUS RECEIPT
DIANA
'----
BLDPRMT1149 15, PLNREV485.51, MECHPRMT78.75, PLMBPRMT111. S/ERU5269. SINSP145
W/ERU1500, W/MTR300. W/DEP40. TRAF757.50, S/DEP50, STFEE4.50
~~~~~~Tg~~':~~~~~iW~nB$jl1\~!'~~~;~~~t...,.
I 1;l;o~TH{"+~'~11 CITY OF
I f ~. YELlVl
I ~ PO 80x479
I ~'elrn WA, 985::17
! . .YE!;,~,.... 360-458-B4U3
I
I
I
I RE~~~VEDEN
*T! THOUSAND FOUR HUNDRED THIRTEEN DOLLARS & 62 CENTS
I
I
!
.~~.:~?~:~;' n
-I
!
RECEIPT No. 3411 7
RECEIVED FROM
DATE
REC NO
AMOUNT
REF NO
EVERGREEN STATE BUILDERS
PO BOX 39753
LAKEWOOD, WA 98499
SITE: 15850 104TH AVE SE 10T53
~:::::-
11/23/04 34117
10,413.62 CHECK
PENDING
MISCELLANEOUS RECEIPT
DIANA
'-----
BLDPRMT 1299.32. PLNREV844.55, MECHPRMT78.75. PLMBPRMT125. S/ERU5269, SINSP145
W/ERU1500, W/MTR300, W/DEP40, TRAFF757.50, W/DEP50, STFEE4 50
~~.~~~i~~~:i.~~~~ _= =F=>~--'~~-~~'8"-~~'-~.~-.- It e
__ ___.~ ""~""'_'__ oU.-.
" ;... &0 e D '" '0 .
PO EO.ox 479
tRim W4. 9E597
360-458-S40~,
RECEIPT No 34118
RE~~~frBN THOUSAND FORTY EIGHT DOLLARS & 73 CENTS
F.ECEIVED FROIJi
DATE
REe NO
"Jv10UNT
F:EF NU
EVERGREEN STATE
PO BOX 197
LAKEWOOD WA 98499
SITE: 15838 104TH AVE
34118
10,048.73 CHECK
PENDING
RECEIPT
BLDPRMT1090.90. PLNREV709.08. MECHPRMT71.75, PLMBPRMT111, S/ERU5269. S/INSP145
W/ERU1500, W/MTR300, W/DEP40, TRAFF757.50, S/DEP50, STFEE4.50
Yelm School District
ATTN. SUSAN CROY
PO BOX 476
YELM I l'lA 98597
360-458-1900
Sold to 16755
EVERGREEN STATE BUILDERS LLC
56622
BUILDERS LLC EVERGREEN STATE
5516 75TH S1 W ~1
LAKEWOOD, WA 98499
# 5606 10 12/02/04
Reg #1 SalesPerson SUSAN
Item # 2900/MITIGATION
MITIGATION OR TVF
i u i 7 i i 1III I -, 1 1 111\
. _ . J' .. ,",>oJ 1 J I I I VV
CK #5202 FOR LOT 51 OF YELM TERRA DEVELO
PMENT
Item # 2900/MITIGATION
MITIGATION OR TVF
1 # 1, 711 00 1 , 711 00
CK ~5202 FOR LOT 53 OF YELM TERRA DEVELO
PMENT
Item ~ 2900/MITIGATION
MITIGATION OR TVF
1 # 1, 711 00 1 , 711 00
CK ~5202 FOR LOT 55 FOR YELM TERRA DEVEL
OPMENT
Item ~ 2900/MITIGATION
MITIGATION OR TVF
1 @ 1 ,711 00 1 , 711 00
CK #5202 FOR LOT 66 FOR YELM TERRA DEVEL
OPMENT
SubTotal
6.844 00
Tota 1 Due
Check
6.844 00
6,844 00
Thank you
PLEASE KEEP THIS RECEIPT I I I
Applicant:
o
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Address. P.O Box 197
Name' Evergreen State Builders
Project Information
Project: Yelm Terra
Description of Work: Plan 1610 R/2B , Lot 51
Site Address 15838 104th Ave SE
Fees.
Item
Building Permit 100-500k 032001-322-10-00
Acct Code
Building Plan Review 100001-345-83-00
Plumbing Permit
Mechanical Permit 032001-322-10-00
032 001-322-10-00
Sewer ERU
Sewer Inspection
Water ERU
Water Meter (SFD)
Water Deposit
Traffic Facilities Charge
Sewer Deposit
State Building Fee
802 412-343-50-01
805 412-343-80-00
712 401-343-80-01
712401-343-80-01
740 402-389-00-00
420 120-344-85-00
742 402-389-01-00
160 001-386-00-00
TOTAL FEES.
o
PAID
Permit Fees Schedule
Permit No BLD-04-0185-YL
NOV 2 3 2004
CITY OF YELM :Ji/ II 2
City' Lakewood
Phone
State. WA Zip 98499
253-475-6622
Assessor Parcel No 85840005100
Item Fee Base Amt
1 090 90 99375
709 08 000
7175 000
111 00 2000
5,269 00 0.00
14500 000
1,50000 000
300 00 300 00
4000 4000
757 50 000
5000 5000
450 4.50
$10,048.73
9715
Unit Rate No Units Unit Desc
Unit Fee
000
56000 173490 $1,000
o 0000 0 0000
9100
7 0000
o 0000 0 0000
000
5,269 00 5,269 0000
14500 1450000
1,50000 1,500 0000
000 o 0000
000 o 0000
757 50 750 0000
000 o 0000
0.00 o 0000
13 0000 Fixture
10000 ERU
1 0000 ERU
1 0000 ERU
o 0000
o 0000
1 0100 Peak PM Trip
o 0000
o 0000
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CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPUCATION FORM
Project Address L c+ ;5 \ Parcel #.
Subdivision '\ "t.\ 1M. -\-~ ('r-.I\ lot #. ..5"" \ Zoning, ~ '^~ \ ~\lV>
z(New Construction 0 Re-Modell Re-Roof I Addition 0 Home Occupation Sign
o Plumbing 0 Mechanical 0 Mobile I Manufactured Home Placement 0 Other
Project Description/Scope of Work. :;.'('. ~ \ ~i\"'" \llfU, " cle..-v\.--t (tH
Project Value .t \ Co 12 b L-L co Co ~ '"t"o eo", ~-tnJc...-\, lJl ~ '-1<1.00
Building Area (sq. ft) 1st Floor ,~~O 2nd Floor - Garage L...lIn Deck-
Basement - Carport - Patio \,-"i t~ :. 2-\6 ~
# Bedrooms:3 # Bathrooms 1- Heatjng:~THER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? AJo If yes, a
completed environmental checklist must accompany permit application
~UILDINGOWNER NAME ~~ ~tte"l c--\ tct-e ~\ \d tf"~ t.... L. t....
ADDRESS"3.8/5 j{)()"M $-1"" $, i..), ~\.Ht-e 1-t\- EMAIL I
CITY L.f\-K.e.wc-o-~ STATE uJ I\; ZIP .'=18<-l~~ TELEPHONE Z-S?:>-L.i.7S- 66Z2
GENERACcQNTRACTOR $~l?.. tr~ O~,^e.7 TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # F\Je("~\l:) '1aOrbEXP DATE~ITY LICENSE #
PLUMBING CONTRACTOR
ADDRESS /BIIE> q:::,~ s.~-
CITY"Ik:~ STATEw.lJ
CONTRACTOR'S LICENSE #
\c.!r TELEPHONE Z-5~-53.7- e9'tV
EMAIL
ZIP 9ert'1.E FAX 2-G"3.-S.>6- er666
EXP DATE CITY LICENSE #
ZIP
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
MECHANICAL GONTBACTOR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable
I hereby certify that the above Information is correct and that the construction on. and the occupancy and the use of the
above described propert will be in accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
~ (I-/l-oLI
pplica ' Signatu~~,:::~ Date
Owner / Contractor ~Contractor's Agent (Please circle one.)
All permits are non-transferable and will expire if work authorized by such permit is not begun
within 180 days of issuance, or jfwork is suspended or abandoned for a period of 180 days
I
I
105 Yclm Avenue West
PO Box 479
Yelm, WA 98597
(360) 458-3835
(360) 458-31-14 FAX
www.ci.yelm.wa.us
"::
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Evergreen State Builders LLC (License "# EVERGSB980PB)
5700 _1001h Street S.W,Suite 630, Box 197, Lakewood, WA 98499
253-475-6622 (Fax 253-4i75-6127)
DESCRIPTlot~ OF MATERIALS for'
YELMTERRA
8' ceilings on first floot
Siding:
8il pre-primed James HardIe lap siding on front, James Hardie single wall
sidmg sIdes and back; James Hardie shakl~s or shake panels as accents
front elevatlon per plan.
Roofing:
Architectural ComposItion roof.
Windows::
-Yjnyl windows to code and as per plan.
Driveway:
Broom fimsh.
Patio/Wallkways:
Broom finish..
, t
Cabinets:
(]lak cabmets, flush panel.
Doors:
Elllbossed package.
..
Exterior:
In$ulated steel, or fiberglass.
Embossed package.
Millwork:
Window Wrap:
Stool and Apron only
Plumbing:
Kitcben!Sink: 33x22, 3-hole, double-sink. St.ainless with chrome delta faucet.
l.avatory:
. Powder Room. whIte WIth Delta chrome faucet.
. }Ian Bath-,- Kilgore whIte sink with Delta chrome faucet.
e Master Bath;. (2) 20x17 white WIth Delta chrome faucets.
. Tub V aly~Master bath. Delta chrome or eqUIvalent.
<81 Tub/Shower Valve. Mam bath: Delta tub and shower valve.
4& Shower vJ!lve. Master: Delta or equivalent.
.. Toilets. white, per plan.
. "
Bath enclosures:
Hot Water Tank:
Hosebib:
Hardware:
Bath hardware:
Flooring:
Countertops:
Painting:
Applianc.~s:
Wiring:
C'
.)
o
Page one of two
'Master bath: Clear glass door on separate shower WIth chrome tnm.
~ubs: Fiberglass white
Gas 50 gallon.
T~o per plan..
;bdcks il!teriOl':;' Chrome
Locks exterior: Clu"ome
\1
t ~wel bars. Chrome
P.jper holders. Chrome
~~ Dinmg room, livmg room, staIrS, bedrooms, closets, 6 Ib , 1/2"
nJ:>ond pad.
Yinyl: IJtIltty room, hall bath and Entry
Laminate. Whole house
Extenor ~frim: WhIte or color from approved hst.
Exterior Body: Flat solid body paint from approved hst.
Front Door: Enamel, white or accent color from approved hst.
Intenor Walls: Drywall sealer coat, then one coat flat latex.
Kitchen and bathrooms. Low sheen enameL
Bimge/Qven. _WhIrlpool whIte
I:::~shwasher: \Vhirlpool Self Clean, Willte:.
!disposal: 1/2 HP
I(;~maker: Refrigerator space plumbed for icemaker.
~iicrow!!ve: Whirlpool white
l'hone (2) cable (2)
';1[:
Page two of two