The URL can be used to link to this page

BLD-05-0270 City of Yelm Community Development Department Building Division Phone: (360) 458-8407 Fax: (360) 458-3144 Permit No BLD-05-0270- YL Issue Date. 11/28/2005 (Work must be started within 180 days) Receipt No 38533 Applicant: Name: American Dream Concepts Phone. 360-882-3218 Address. 390 4th Ave SE City' Pacific State: WA Zip 98047 Property Information: Site Address: 10428 Grove Rd. SE Assessor Parcel No. 64303100704 Subdivision. Lot: D Contractor Information: Name: Applicant Address. Contact: Phone City' State' Zip' Contractor License No Expires. Business License. Project Information: Project: Lot C car port Description of Work: 176 s.f. carport added to permit 04-143 Sq. Ft. per floor' (1 st) 0 (2nd) 0 (3rd) 0 Garage 176 Basement 0 Heat Type (Electric, Gas, Other) OTHER Fees: Item Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc --------------------------- ------------- Building Permit - Other 8183 000 000 o 0000 o 0000 $1 000 Building Plan Review 53.19 000 000 o 0000 o 0000 State Building Fee 450 450 000 o 0000 o 0000 TOTAL FEES. $139.52 Applic:ant'l? Aftadavit: 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 restricti?l!~ of record.)f ~pplying as a contractor, I futher certify that I am currently registered in the e.' hington......... .. .. /,,::';"""" # Sets of Prints. Final Inspection: Signatur Date 1/""- 1- os:- Date: By' Firm City of Yelm Community Development Department Building Division Phone: (360) 458-8407 Fax: (360) 458-3144 Permit Fees Schedule Permit No BLD-05-0270-YL AppIT~~nt: Name: American Dream Concepts Phone: 360-882-3218 Address: 390 4th Ave SE City' Pacific State. WA Zip 98047 p'roje'~t;ln~prl!!atioh:(,O\ . Project: Lot C car port Description of Work: 176 s.f carport Site Address. 10428 Grove Rd. SE TOTAL FEES Assessor Parcel No. 64303100703 Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc ------------- 8183 000 0.00 o 0000 0.0000 $1,000 5319 0.00 000 o 0000 o 0000 450 4.50 0.00 o 0000 0.0000 $139.52 Item Acct Code Building Permit - Other 032001-322-10-00 Building Plan Review 100001-345-83-00 State Building Fee 160 001-386-00-00 .j) ..... (7 I t..17;J ': ."""....m.n._,"..."n..m___;________'_mm_:__.m__._____:_..n.. :""~ ...." l(J)tf~8 '.,. (f80iL(tr'g~'i ~"',...'.........................i.....i...i.......!....iii.......f........,.',........ .....,.,.,...,......i.. ............. .......... ".".,.,.~........."..,....,...........................,......'.!r:r..~......,.....' . ,- . ";~ 'tJC) , ......,.. 2 ' , ,. , ...'.., " . . ~jJ+(h:' : ' L . , .' '-, Wi..r.c219r>'..1 $-h~~Jlt;g ,.............. .. m_..'_.,..,...._,_.__._..._.,..... Rn':'S5iJ1..efi... lS/<2Ek . Z~4\)<-2.'5 ~ ......, .+ ,k. "+ f->'~il(2-F5 :3 {ZcL lJlt'/kl2 .' L .. ," .......j.t'..i' [JJacKri'..l<;;......... ~ ~ FA< L S ~,e&3 3- q L/I ('/ . 'riD! /I~o-0(t~..fE r .~ .......:.......... ...............+T..'i...... /J _ i.: ,"--"'''' ... .' ._n._...;_m.m...;.. Ukf,6'6-r. .. · y~q . 6'Alv &{IH~ kr~' ~Q ff.4:, 2-- '.r" 0['.' 2>GLi DF ~L.r I( I I '1. ~ aL Z""Lt ~'F1!fV<<;Ec { , . ' ; .. ~ : r ,.........:".. --; ,..+..:~, I Project Name Project No File No Date 8 POBox 6728 Bellevue, WA 98008-0728 (425) 451-8877 Fax (425) 453-5680 www.gly com CONSTRUCTION L ll\ :2 ....... ~ , ~ ~ >-.. t- \J. ", '-:l ~ o ~ 10'/2 8 G-f<OVE f?O R<?l ~.% P;'+ch Pr eS.5iJl,ee. !S/ ()ck . t Z_x L/ vZ Z.o '5 .~ 2YLj)(Z2g5 :5 r L4.iki!.AL B'/ DcKltV' (r Project Name Project No File No '-I ~ J 7- 0 F l?CItJV1 J2y) H.T-I.Ul.,.... rl 0 veetM '-J& RA.tfee ZLI/I o.Lj 2;.4" oveR. <- I HAtvCr 5' ~ .... '/~EATeo f- Lf xG 0(1 EJ,t e.... 4 I /0 1$'/ <. ->/01'(1 z (%, Zit , , g"~'fe.p s'LA13 '1" lAkf {6J LJ x L( {FA '\/ g {/:Ie tr-J. II I " ,- ,. I -z" ,- Date 8 POBox 6728 Bellevue, WA 98008-0728 (425) 451-8877 Fax (425) 453-5680 www.gly com CONSTRUCTION Look Up a Contractor, Electnclan or Plumber LIcense DetaIl Page 1 of 2 Topic Index Contact Info Workplace Rights & Licensing Claims & Insurance Find a Law or Rule Get a Form or Publication look Up a Contractor, Electrician or Plumber General/Specialty Contractor A business registered as a construction contractor with Lftl to perform construction work within the scope of its specialty A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance License Information , . License AMERIDC951 BM Licensee Name AMERICAN DREAM CONCEPTS LLC Licensee Type CONSTRUCTION CONTRACTOR UBI 602460080~erify Workers Comp Premium Status Ind. Ins. Account Id Business Type LIMITED LIABILITY COMPANY Address 1 390 4TH AVE SE i Address 2 City PACIFIC i County KING State WA Zip 98047 1 Phone 2537352222 Status ACTIVE , Specialty 1 GENERAL : Specialty 2 UNUSED Effective Date 1/1412005 Expiration Date 1/1412007 Suspend Date Separation Date ! Parent Company Previous License AMERI DCOO4BL Next License , Associated License ........ Business Owner Information I https.l/fortress.wa.gov /lmlbblp/Detail.aspx?Llcense= AMERIDC9 51 BM 8/26/2005 Look Up a Contractor, Electnclan or Plumber LIcense Detail Page 2 of2 Name Role Effective Date Expiration Date BURBRIDGE, JAMES G BAKER, MANNACE E IV PARTNER/MEMBER 01/14/2005 PARTNER/MEMBER 01/14/2005 Bond Information i Bond Bond Company Account Effective Expiration Cancel Impaired Bond Received Bond Name Number Date Date Date Date Amount Date OLD REPUBLIC SURETY Until #1 CO YLl248839 01/12/2005 Cancelled $12,000 00 01/14/2005 ',~."", ;",,, , Savings Information No Matching Information Insurance Information Company Insurance Name Policy Number WESTERN PACIFIC MUTUAL INS CO WPGL4600022605 01/13/2005 01/13/2006 Effective Date Expiration Cancel Impaired Date Date Date Amount Received Date #1 $1,000,00000 01/14/2005 Summons I Complaints Information No Matching Information StqctqNewSea,rch E'rinteI.fr1eJJ.dlY.YersjQIJ About L&! Find a 1-800-547-8367 at L&I I Informacion en espana! I Site Feedback I W State Dept of Labor and Industries Use of this site is subject to the aws of the state of '\ccess lI"r 'ment I Pr and socurit stat ,ent I Intended Jse extemill content pOlicy Visit access 'Na.gov Staff only link https.//fortress.wa.gov /lmlbblp/Detai1.aspx?LICenSe= AMERIDC9 51 BM 8/26/2005 crf'{ of' '{ELM - 6UILOI~G OEPA.R1ME~1 RESIOE~11A.L CER11f'ICA. lE Of' OCCUP A.~C'{ Building /\ddress ~ ~ owner Name ~ coostf\lctiOO owner /\ddress ~ pacific W/\ 98047 Building permit Number BLD_04-0~43-,{L Plan Number Rema,kS --------=====ooe =------ Areas Inspected !\II code re uired special conditionS ~ Date october '17 2005 Building Ofticia\". G. carlson ~ , ' ' I' e '11\\0 toe toteroatiooal Resideo(lal Code (coapter 5;~~~ ~~~'::~~o~~':Pb~~~e wasolngton state Buiidlng Code Council putSuaot to Coapters 1 9 21 and 10 92 RCW. effectNe July 1. 2004 i V h o o CITY OF YELM INSPECTION LOG c PROJECT ,6" ~ - /.eJI- Q PERMIT NUMBER CJ~- C?/v3 ADDRESS /ol/I/P 6"O~ M UC FOOTING WALL 12" 6" <:::1)' ~ other other reqmred vents SET BACKS Date Front Rear SIde/Flankmg SIde FOOTING REBAR / Date~WALLREBAR V"'Date ry.r1 Comments COMBIl\TED FRAME/ E, XTERIOR SHEAR WALL INSPECTWN Hold downs ~_ Shear Nallmg (fL/ "'h!J1 bh? C Frame, . ~ Gas/Propane I / I Plumbmg , ". ' Mecharncal ' .J~4 ter i W .:..tk g G "3.&41 comments_~b ~ ~ ~I''''-''k.. fPL114~ INSULATION Gas Electnc other Foam and Seal Vapor bamer PV A Comments SHEET ROCK/SHEAR WALL NAIL Comments OTHER Comments FINAL Se\\ er Flllal j;fdress Comments Landscape F mal SIdewalk /\ ~ --I J /1 -- 13'-<l"-----~ ~~ 5'~~--,- 0 '=-==- 9~2~:..:::~-----------:-~-- 20'00' ~--~~~ "46 ((:>> d)/ ~II c=~_ '~::::: Mu Master - Laundry , ill Bath Room ~ ~ ((?j)11 n -=__ ....., ./ / b I Co N ~ ---1 <=""'".....=." r=:1 (0 , Co b , ~ ..... -D Master Bedroom ~- b , Co --f c,> M -i Kitchen ~ 'J1 1- , \t=:f Dining B 2468 b o M co <0 o <0 >/ ~f /, V ~ (j '-../ ~J I' / /~~~;C)O -~ {~ o ~ Art Niche ~ ~, I~ ____IJ_____ , / .a ~ \ (0) ~ Lov\L..-- 0/ ( 6'6"6' -,-~ _,::,- o f Office/ Master Retreat \/y/~ r- 3'-4 1/8"11 ~ C;,\) D co <0 """ N uS 266' /-~ \ ..... " Built In TV Wall Ln , ~ 1/ Walk In Closet ro~'O 'V 5 b , M / A V Components // ~~ b o N -1 20'-0" -------------- c::= 6068 .......-. t- o m ~,~ -l ~ J) ~ jp, \ ---3068-~~_ '-___-1- -- -----48'-0".------- 32,-:.2~ _=__~6 2046 ~ b -' ~ ___J Living Room -i co 8 &0 ----........." 14'-9 1/2" -- 12'-10" -------------~'fo" ~ \\- ~ :'. ~,~ \ lower floor area 1344 square feet _.~- upper floor area 1344 square feet <:I?l ------- .0 0_. -----~ tp!r5~ -------.-.-- .-----.--.---;' 'j/7P; - \ model: SANT en ~ I- v 0... ~ W ~ () ~ Z ~~ o UJVN ()V>ox ~ 00 c:J >0\"4- ~ <<~ <( ..c ~ 00 w;uv ,y '- (Y') LL. "4-' o ,_ (Y') o 0\ u (Y') (Y')c:J00 Z ~cv) <( 10 () ~ - u cr: ~ W "4- ~ 0 <( .~ <V > ZO:: <(0 ~O ....J u.. date 2-23-04 drawn by' Mann Page 1 / 5 ---.. ---:::::::::::~- '\\ \ ' \ \ \ \ \ \ \ \ \\ \ I \ \ \ \ \ \ \ \ \ ' \ I \\ \ \ \ \ \ \ \ \ \ \ \ \\ \ \\ \ \\ \ \ \ \ \ , \ \ \ \ \ \ \ \ ~ \\ \\ \ \ \ \ \ \ \ \ \ . \ , \ \ \ 5'*0"~' I. 15'-0"~ \ \/-= S'-'J' /"tc 3'.0. - ...>- ~'\' ~ \ \ \ ~- \ \ \ \ - \ \ \ \ \ \ \ \ \ \ \ \ ~ ~ . q \ \ \ I -q() ~b ><(j) ~tn .~ ~ \ I ~ \ , \ \ i \ \~ \ \\> \ \~\ '-4~~.\ \ 0 -0 (0 \ \ tii (0 ""'\ \ --""'\ ~ \ -n~0 --00 \ \ g ~ ;, \\\;~@ \ ""'\ (0 n> \ ~ n> ~ \ ~v.> \\ ~~~ II ~~(f) \ \ (f) (f) -g \\ -g-g ~ \\ O)~(O \ \ ""'\ (0 -n I, (O-n(O \\ (t(O ~ \ \ (0 ~ \ ,..... \ \ I \ \ \ \ \ \ \ \ \ \ I \ \ \ \ ~ 0- \\ \, -------0 \\ -? ~ ' \----- 0> >< '" \\ rv <.0\ ~ !l 1\ - a> ::J \\ (j\ \ \ \ \ \ \ \ \ \ r \ \ \ \ \ \ \ I i I \ '()?, .- q I \ \ I \ ~I\ ~ C- O) ..... , (l) \ CUI ~\ \ \ \ \ I ~\/ 3 \ i I I ! I I I I I I ! I \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ I \ \ \ \ \ \ \ \ \ \ I \ \ ',t, 4046 'OJ '(t) '0- \ -"'\ \0 10 \3 \:tt:. \rv \ (f) ~O .I> -"'\ ~G) c.<.O ~ CD ';0;0 ~o o 3 \ , veiW' AMER\CAN DREAM CONCE' % ~\ UppE.R 390 4th AveSE (;J \ Pacific W A 98047 ~ \ fLOOR office 253.833.3487 faJ< 253.83; -~- \ .--\ .er. \~" ~ , \ I \ \ 3066 \ OJ o :;:) c (J) ~ ___________18'-0" o "3 \ I I \ -, -.\-- \ \ I \ \ \ I \ , \ I \ I I , \ , \ \ I \ \ I I \ \ 0" I, U"'> I \ ~I \ \ \ \ \ <...r; /'''." - -, )\ I \ / . \ 7- // ~, // \ ~/' I \ "" (f) 0 t" CO ~% 0% (t) -"'\ :;:)- co ""'\ v-) 8 I ~ ~ I G) CP \ ~"" _. ~ OJ X~ :;:) /,(~ OJ / O!:r. 0) q \--i\ :;: \ \ \ 266~ \ \ \ / ...>- ...>- ~ OJ (t) 0- -"'\ 0 \ 0 \ ...() \\ ~ "3 I ~r i "iQ I \ ><(j) ~ \ ~~ \ ~ \ \ I \ I \ \ \ \\ \ \ \ I I \ \ L- V , \ '\ \ \ \ \ ' , \\ \ \ \ \\ \, , \ \ ' \\ \ \ \ \ \\ \ \ \ \ \ \ \ \ \ \ \\ \ \ \ \ \ \\ \ \ \\\ \ \\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ ~-- ----- /%\ ~\ . . \ r)\ \ ~\ \ \ ~\ \ \ g\\\ z\ (/)0 (\) ~. ~ eft 10 ,.... --- q r- ~o Soz ~\ ~ 14'_1"~\1 \ ~ ~ C'~ ~ - ~ \\ '> ~ ~. >, -r v.. 11"1 ' tJ\ -r - ~ ~ \ \\ \\ \\H \ \\)> \ II ~ \ \ \- ~=-:-\ \ ~ """\ ~ -n~o - 0 0 \ \ 0 0 """\ '\ \\ 0 """\ ~ """\ n'\ """\ >"~(t) """\ (t) ~ ~ ~ ~ ~v:>\ ~~t. \ \\ ~~(I) \ \\~~~\ \ c:. ~ """\ \ ~"""$t) \ \"""\(t)-", \\\ ~ ro ~ \ (t) (t) ....... (t)....... \ \ ....... \ \ \ \ \ \ \\ \ \ \ \ \\ \ \ \r \ \ \ , \ \ \ \ \ \ \ \ \ \ ' \\ 2~$ AMER\CAN OREAM caNCEl 3904"\"h AVe SE Pacific W A 98047 office 253.833.3487 faX 253.83: (JJ ~ \ s ~ \ t, ~\e~~\JNO,.:nON _ ~ ~ ~ tf \ ~NorLOOR ~/)~ / ~~M\~G %\ 0.. '\ 9!. n"" \ \ \ \ \ \ \ \~ \ \> \ \ \ . \ \ \ \\ \> \ \ ~-=/-~-\ \, -U5~ \ \\ 0"'0 ($ "\ni (\) ~ \ \ -- ~ ::!3 -n::!30 \ -- 0 0 \ \ 0 0 ~ o ~ t\l \ ~ 0) ~ '"h~(\) ~ (\) a> (\) 0) t\l ~ ~()) O'>.$>.$> 'CO.$>(J) \CP(J),O. \ ~ ~ ~ \ C t\l ~ \ t\l ~ (\) \~(\)--h \ \ (\) --h ro \\ (\) 9l- ~ \ \ 9l- \ \ \ \\ \ \ \ I \ \ \ \\\\ \ \ \ .. L/ "\) S. \ 0) n'\ \ ~ <0 :5 \ _ CO ':) \(]\ \ it ~ ----- ! \ I \ \ \~'\ ~ \ \~ ~\-- '" bt -.\' ~ // .--' 'Z o en flo \ ~ \ c-o. o. ~ ~;O\\ ~-n %. ~ \ \:\ ~ ~ ~ \ \: z\ (i) \ ~\ '" ~ -', \ \ - '\ ' ~'\\ , I' '" \ 'I --==4\ i.j 10 ~ \,q \ \ \ \ ' I :, \ , \ \ \ \ rl?~~ \ \ ~. --== \ \ ==--===-= . ~ ===== \ ,J \ ',\ . II \ 'I .\ \ '~ \ \ ~. " k .vLql,J\.-.~l.:~~~=~ ~ 'I \~ , i / 1\ 1.- 'T \ \\1 ~ 8; \ tv 0.. \'JeN'{ ~ \ ' %-' :J \ tv \ !l I Cf \ . \ 0 \ ~\ J\MER\CJ\N OREJ\M CONCEI 390 4th Ave SE Pacific W A 98047 office 253.833.3487 faX 253.83: \ \ <:t \ :t~rt9'Z)(1)} L9\7t'tt~rt9'Z 'a:)!}}O \' \ 0 c. \!') \ L\7096 V M :)!}!:)'Od NO\1. \;( ^ \;(3"13 ~ ~ ~ <g, - \ 3S 'aI\V \\.\.\7 06t \ ~ ~ % ~ c:\1 \!') \ 13~NO~ ~";f3"t10 N";f~\"t13~";f, .~~----;; ,{f \ ,I $~\\ / /;; \~\\ \ \'\ / / \ \ \a;a;a; 1\ Q)~~\ gww ~~(jJ ~~(jJ ct)ct)<.O ~~(".1 co co co \~~~\ \-\-\- \ \ g ~ ~ \\ \ c+: ':. U- \ \ Q) ~~ .! i~o.O\\\ \ - :) \- L--~ \\ \ 1 \ \ \ \ \ \ \ \ H\\ , \ \ \\\ \\ \ \ \ ' \ \ \ \ \ \ \ \' \ \ \ \~ \ \ \ \ \\ \\ !\J / / " :\ \ \ \ II \ \ \ \ / / / / I /1 /I~~ /~~~ I ' \ \ \ Q \ \ \ ! \t===G \ \ --=' I / / , "". "- \ "- .... ~ "'", ""\ "\ '" ""'-."'-.~ "- ~ "- '" \ "'- .... , 1 " ' \ '-. '-. " , " ", " , .... " '.....~ ", .~ " 'I, "'., . ~. / "'y It ........ l \.~ '~~ ~ "-\. ':-" ,. " . . - Q) ,-0 \0 E o o City ofVelm Community Development Department Building Division Phone: (360) 458-8407 Fax: (360) 458-3144 Permit No BLD-04-0143-VL Issue Date 10125/2004 (Work must be started within 180 days) Receipt No 33607 Applicant:",'" . Name Baker, Manace E Phone. 253-261-0572 Address 390 4th Ave SE City' Pacific State: WA Zip 98047 Property Information Site Address 10440 Grove Road Assessor Parcel No 64303100704 Subdivision, N/A Lot: D Contractor (l'iforlTlation Name American Dream Construction Contact: Phone, 360-882-3218 Address 390 4TH Ave SE City' Pacific State. W A Zip Contractor License No AMERIDC004BL Expires 01/15/0515 Business License, Project I nfor.I!!}3.t.ioll Project: Mannace E Baker Description of Work: 2240 SFR Sq FL per floor' (1 st) 1344 (2nd) 1344 (3rd) 0 Garage 0 Basement 0 Heat Type (Electric, Gas, Other) ELECTRIC Fees. Item Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc --------------------------- ------------- Building Permit 100-500k 1,252,64 99375 258.89 5 6000 462300 $1,000 Building Plan Review 529,24 000 000 o 0000 o 0000 Mechanical Permit 159 50 000 000 o 0000 o 0000 Plumbing Permit 104 00 2000 8400 7 0000 12.0000 Fixture 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 State Building Fee 450 450 000 o 0000 o 0000 TOTAL FEES $3,889.88 Applicant'~ Aff.Cidavit: OFFICIAL USE ONl:.Y 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 ra:Of~~a\'hi09too.. } Signature ~ ~.., Date I () , 1. 5/ D 4L Firm B1t';:ri~~~ii~r~<~~~.A~~<j~!iIl (iJ,b;I.,~I:;l.~L~il:l1J1li!'>l--:I;,J i.J"'~~;.1';l;r~l~~l'~~:iI =--!g:~:j\~e.l ~.I~1!H~ ~~};!~"}:\~;;il ;.C;, ,'. ['~~~CITYOF 0 -- 0 ! i~~J~ YELM I / "--. PC Sox 47e; I'" '{slrn ,i/\ 9A597 l 160-4': 3-840:3 I ! I RECEiVED . ****THREE THOUSAND EIGHT HUNDRED EIGHTY NINE DOLLARS & 88 CENTS i I I RECEiPT No 33607 RECEIVED FROM DATE REi_, ~jO Afv1CIj~.JT REF Ni! MANACE BAKER AMERICAN DREAM CONCEPTS 390 4TH AVE SE PACIFIC WA 98047 BLD 04-0143-YL 10/25/04 33607 3.889.88 CHECK 2795 ~...---:.-.~--"'-""'-' ~?-./ BLDG PERMIT B D-04-0143-YL WTR ERU 1500, MTR 300. WA MISCELLANEOUS RECEIPT GRETCHEN 2.64. RVW 529.24. MCE 159.50. PLUMB 104 BC 4.50 10440 GROVE RD . ~ IJ:' -...."" "" ".. ~ . o. t.' RECEIPT No 33608 RECEIVEn -***THREE THOUSAND EIGHT HUNDRED EIGHTY NINE DOLLARS & 88 CENTS RECEIVED FROM DATE REC NO Afv10U~H REF NO MANACE BAKER AMERICAN DREAM CONCEPTS 390 4TH AVE SE PACIFIC WA 98047 LOT A 10/25/04 33608 3.889.88 CHECK 2795 MISCELLANEOUS RECEIPT GRETCHEN BLD PERMIT 04-0142-YL 1252.64. RVW 529.24.MECH 159.50. PLUMB 104. WTR ERU 1500. MTR 300. WATER DEPOSIT 40. BC 4.50 10434 GROVE RD I~ It Thurston County Public Health & Social Services On Site Sewage Systems Permit # 03-034792-630 c' .( \ J \ t-,~!- Ii 0 "- ~I! . L \.., t. \__ I \ ( ( .l llui Property Tax #. Site Address City' Subdivision Sub Type Work Proposed Permit Description 64303100704 Lot #. u Plans Approved By' Issued Date 05/19/03 Issued By' Vince McDowell Expire Date 05/18/06 UNKNOWN On Site Sewage System New' City Applicant: Address OSS Designer' Address MANNACE E BAKER 386 4TH AVE SE PACIFIC, WA 98047 Paul Morneau/Alternative Designs Po Box 1962 Yelm, WA 98597 /343 Phone (360) 458-9548 Info Proposed Sewage System Use Residential. S Number of Bedrooms This OSS system is experimental Disinfection OSS serves a food establishment No Tank 3 Water Supply Type Concrete Pre/treatment Group A None None Transport Pressure distribution Disposal No An Operation & Maint Cert is required No Trench sand-lined (C33) Access Issues Directions. PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. Installation must be in conformance with the stamped, approved design for this permit number This permit may be revoked if the site conditions have changed since the design was approved. The on-stie sewage system may be installed only by an installer certified in Thurston County or by the resident owner of the property A resident owner installer must contact the Environmental Health reviewer prior to construction. Depending on the specific situation the resident owner installation may be subject to multiple inspections. This system may not be used until the final As-built drawing is accepted by this department. For FINAL INSPECTION. call 360-786-5400 Page 1 of 1 o o COUNTY COMMISSIONERS Cathy Wolfe District One Diane Oherquell DistrIct Two Rohert N Macleud District Three THURSTON COUNTY III \-'U'!'a.": IIl'I tm~1!I!l tI!IiIlI_'lIJI~1II SINCE 1852 PUBLIC HEALTH AND SOCIAL SERVICES DEPARTMENT October 12 2004 \ i \ \ ~ i \ r \, . \ Sherri McDonald, RN, MPA Director DIana T Yu, MD, MSPH Health Otftcer MannIe Baker 390 4th Ave SE Pacific W A 98047 S~lb.lect On site Sewage Permit ApplIcatIOn # 04-113S<">8 Parcel # 64303100700 Dear ApplIcant On August 27 2004 you applIed for a pem11t for an on site se\\'age sjstem (OSS) for the above referenced parcel That applIcatIOn IS now approvable In order for this agency to release the permit to mstall the O~S all outstandmg fees must be paid. Enclosed IS the 111\ o!ce showmg all fees due to Env Ironmentai Health Yau may pay the fees m person at the Permit ASSistance CentL:r Thurston County Courthouse Butldln~ 1 and obtam the permit at that tIme, or you may mati the lLcs to the follnwmg address, and we wtlll11atl the permit to you Please include tlte permit number amI parcelllllmber 011 VOllr renllttaJ1Ce alld mail to. Thurston Count] EnVironmental Health Department Att On SIlL ~upport Staff 2000 Lakcndge Dr SW ()!Yl11r11 'W.\ 9X502 Please request that your deSigner submit the final asbuIlt clr3\\ II1g a~ ~oon as possible after OSS Installation occurs If yOll have questions please feel free to call our office at (360) 754-3355 e'\t 6518 slI1cereJY) ~~ 1,-,-- Heather Devll1e Jones Environmental Health Program ASSistant EnVironmental Health DiVision. 2000 Lakeridge Drive SW, Olympia, Washm~ton 98502-6045 Fax (360) 754-4462 · TOO (360) 754-2933 www.cLl.thurston.wa.us/health <I ReC",'c1ed Paper 100 Cr My Plot ~IAV\ I~~O' THE p~~1 ~ ~ LA I { SOVl"O *0 be de '/efty1tl1e d RECEiVEL JUN 2 9 1004 CITY OF YELM PO Box 479 Yelm WA 98597 Community Development Department 360-458-3835 FAX 360-458-3144 RESIDENTIAL BUILDING PERMIT APPLICATION APPLICATION EXPIRES 180 DAYS FROM DATE OF SUBMITTAL. TO EXPEDITE PROCESSING, PLEASE VERIFY All DOCUMENTATION FOR ACCURACY All CONTRACTORS ARE REQUIRED TO PROVIDE A COPY OF THEIR CONTRACTOR'S REGISTRATION CARD AND PROOF OF A CURRENT CITY OF YElM BUSINESS LICENSE. IN ORDER TO PROVIDE PROMPT AND EFFICIENT SERVICE, WE NEED THE FOllOWING DOCUMENTS SUBMITTED WITH PERMIT APPLICATIONS . Identification and description of the work to be covered by the permit for which application is being made . Description of the land on which the proposed work is to be done by legal description, street address or similar description that will readily identify and definitely locate the proposed building or work. . Description of the use or occupancy for which the proposed work is intended . Two complete sets of construction plans, diagrams, computations and specifications, and site plan including septic and/or step tank location (See Samples attached) . Stated valuation of any new building or structures or any addition, remodeling or alteration to an existing building . Signature of the applicant, or the applicant's authorized agent. . Energy calculations. . Civil plans and specifications, if applicable . Any additional data and information as may be required by the building official . Copy of mitigation agreement with school district, if applicable THE FOllOWING ITEMS ARE NEEDED WHEN SUBMITTING AN APPLICATION FOR A SIGN PERMIT . The name, address and signature of the owner of the sign . The street address or location of the property on which the sign is to be located and the name and addess of the owner of that property . The type of sign or sign structure. . A site plan showing the proposed location of the sign relative to the boundary lines of the property where it will be situated, the locations and square footage areas of all existing signs on the same premises, and the location of all abutting public rights-of-way, building and other structures on the premises . Specifications and scale drawings showing the materials, designs, dimensions, structural supports, and electrical components of the proposed sign R:\Community Development\Forms & Procedures\Building Permits\ResBldgPermitApp.doc Page 10f3 o o CITY OF YELM RESIDENTIAL BUILDING PERMIT APPLICATION FORM Project Address.~ D SE (.rRov~ IZJ. Parcel #. G 4303100 -70 l{ Subdivision Lot #. D Zoning, P5- New Construction D Re-Model/ Re-Roof / Addition D Home Occupation Sign D Plumbing D Mechanical D Mobile / Manufactured Home Placement D Other Project Description/Scope of Work: ~. i ~l~ i= A. ~v\ ok, Re..s\dc Vile.. . I Project Value \ b D \< Building Area (sq ft) 1 sl Floor ~ 2nd Floor Garage Deck Base~-;;;r I s Y '1 Carport Patio # Bedrooms '3 # Bathrooms2 5 Heating GAS/OTHER o~ircle One) Are there any environmentally sensitive areas located on the parcel? f\ () If yes, a completed environmental checklist must accompany permit application. BtJYtDING:;oYVNER.N,AJvlE. AObRE"S' "-"'ifD' "<t::-:r.h A CITY STATE ( A\'RC "d...N:G[~.~I;"~ > A W\~ ADDRESS CITY STATE -w: q~Ol..1l TELEPHONE 75"'3- Zl.../- OS-I L LICENSE # ZIP TELEPHONE G'EN'E"Rf\Lc,0'NmRAQTQR Ab6R~S~!l/)'"'' Lfl], .-. v sG- CITY . Ir C."l STATEi.>>A CONTRACTOR'S LICENSE # ZIP TELEPHONE C"r1uh qnO'-I'l FAX EXP DATE 7-';'-5 2 (; ('OS 7"Z.. Z~J' ft?S- LIL/'LJ CITY LICENSE # ~CpMBfNG:.GQtfr;g,Ap~Q'R ADDRESS CITY STATE CONTRACTOR'S LICENSE # TELEPHONE ZIP FAX EXP DATE CITY LICENSE # MEeHA~rfcAEri.CONT;RAdTOR .~,-,,".., "-" ",...-- "".. ,..,'~.,-,.. ',-,,' ..,~.,.,. "'.,,.,'.,., -,-,...' .,...... ~... ADDRESS CITY STATE CONTRACTOR'S LICENSE # l^vv1L~C: M,;1t'.J TELEPHONE ZIP FAX EXP DATE CITY LICENSE # Copy of mitigation agreement with Yelm Community Schools, if applicable (j ,- z 7 ~OC J ~" ApplicantTs Signature Date Owner / Contractor I Owner's Agent I 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 R:\Community Development\Forms & Procedures\Building Permits\ResBldgPermitApp.doc Page 2 of3