BLD-05-0221
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crn' Of 'lE\.N\ _ 6\.lI\.OIl'lG OEP /l.R1N\EI'l1
RESIOEI'l1\/I.\. CER1\fIC/l. IE Of ocC\.lP /l.I'lC'l
euilding Address
~62n BirK\and st SE.
~
p\an Number
owner Name
owner Address
eui\ding permit Number
~
RemarKs
----
{\\\ Code renuired
Areas \nspected
special conditiOnS
Date
~
eui\ding o~ticia\.
~
. . 10telO.(Ioo.1 Resideoti.1 Code \Ch.pter
ThiS structure is io COlOPIl.oce ;;.t ~~: toO st.te Buildi09 Code couocil pursu.ot
5~-5~ WAC) as adopted b,/t 2n7e d.~O ~2 RCIN e"ective JulV j, 2004
to cnapters ~9. an '
_,=~mm~ ~f~@W-
-:"::>1 YELM SEWER DEPT
FAX NO 360-458-E3166
Nov 15 2005 03 00PM Pi
FAX TRANSMISSION
CITY OF YEL~1
\ PO.BOX479-931 NPROADNE
\) YELM, W A 98597
~~~\ FA~~6~~:;~~~:66
TO &~f/EAJ DATE. /1-;5-1..>''''-
FAX#:
PAGES- i , mcludmg this
Cover sheet
From' '(::'fWDY
Sub J eel I-i(w ') If' FI,J/i L/ It un u tv"..J H ILL Ti"
COMMENTS' J- 61 L~ /0d.-I"l 13 1 RCV,LA)JtJ
61-- 0 to 10 . D 0
H Ifyoll do not receive all COplCS or any copy IS not legrble, please call (360) 458-8411
as ~oon as pOSSible
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CITY OF YELI\1INSPECTION LOG
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PROJECT
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Comments ,-J\.. llp~ )0,(
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:--, Other
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360)458-3144
Permit No
BLD-05-0221-YL
Issue Date 07/19/2005
(Work must be started within 180 days)
Receipt No
37378
Applicant:
Name: Landshapes NW, Inc.
Phone.
253.537.6370
Address. 1151 E 112th Street
City' Tacoma
State. WA Zip 98445
Prop~1jy Information:
Site Address. 16217 Birkland S1. SE
Assessor Parcel No 32660000400
Subdivision. Autumn Hill, phase II
Lot: 4
Contractor Information'
Name. Landshapes NW
Contact: Lubbesmeyer, John
City' Tacoma
Phone. 253-537-6370
Address 1151 East 112th Street
State WA Zip 98445
Contractor License No. LANDSN1965MT
Expires. 08/13/06225
Business License: 1673.0
Pr()ject Illforl11Clti()1l
Project: Autumn Hill, phase II
Description of Work: 1320 sf SFR, Lot 4
Sq Ft. per floor (1st) 1320
(2nd) 0
(3rd) 0
Garage 430
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 ,139 35 993.75 145.60 5.6000 26.0000 $1,000
Building Plan Review 740 57 0.00 000 0.0000 o 0000
Mechanical Permit 7175 0.00 0.00 0.0000 0.0000
Plumbing Permit 9000 2000 7000 7 0000 10 0000 Fixture
Sewer ERU 541700 000 5,41700 5,4170000 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 000 o 0000 o 0000
Traffic Facilities Charge 757 50 0.00 757.50 750 0000 1 0100 Peak PM Trip
Sewer Deposit 5000 5000 000 o 0000 o 0000
State Building Fee 450 450 000 o 0000 0.0000
TOTAL FEES $10,255.67
Applicant's Affadavit:
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 t State of ashi, ton.
t
OFFICIAL USE ONLY
# Sets of Prints.
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Firm
By.
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Applicant:
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City ofYelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Name: Landshapes NW, Inc.
Address. 1151 E 112th Street
Proje~tlnformation:
Project: Autumn Hill, phase II
Description of Work: 1320 sf SFR, Lot 4
Site Address. 16217 Birkland S1. 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 802412-343-50-01
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 420120-345-85-00
Sewer Deposit 742402-389-01-00
State Building Fee 160001-386-00-00
TOTAL FEES.
Permit Fees Schedule
Permit No BLD-05-0221-YL
Phone:
253.537.6370
City. Tacoma
State. WA Zip 98445
Assessor Parcel No. 32660000400
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
-------------
1,139.35 993.75 145.60 5.6000 26.0000 $1 000
740.57 0.00 0.00 o 0000 o 0000
7175 0.00 0.00 0.0000 o 0000
9000 2000 7000 7 0000 10 0000 Fixture
5,41700 000 5,41700 5,4170000 1 0000 ERU
145 00 000 145 00 145 0000 1 0000 ERU
1,500 00 000 1,500.00 1,500.0000 1 0000 ERU
300.00 300.00 0.00 o 0000 o 0000
4000 4000 000 o 0000 o 0000
75750 0.00 757 50 750 0000 1 0100 Peak PM Trip
5000 5000 000 o 0000 o 0000
450 450 0.00 o 0000 o 0000
$10,255.67
RECEIPT No.3 7 3 7 9
RECEIVED
*****NEGATIVE AMOUNT***
RECEIVED FROM
oLANDSHAPES NW INC
DATE REQ.NO.
07/19/05 37379
AMOUNT
10.255.67-CASH
REF NO.
CORRECT
BUDGETARY
DIANA
PO. Box 479
Yelm, WA 98597
36()-458-8403
RECEIPT No.3 7 3 8 0
RE~BM6FEN THOUSAND TWO HUNDRED FIFTY FIVE DOLLARS & 67 CENTS
. RECEIVED FROM ,
~ANDSHAPES NW. INC
1151 E 112TH ST
TACOMA. WA 98597
SITE: 16217 BIRKLAND ST SE
BLD-05-0221-YL
DATE REC. NO.
07/19/05 37380
AMOUNT
10.255.67 CHECK
REF NO.
2476
BUDGETARY
DIANA
. S/ERU5417. S/INSP145
W/ERU1500. W/MTR300. W/DEP40.. TRAFF757.50. S/DEP50. STFEE4.50
RECEIPT No.3 7 3 7 6
RE€E~N THOUSAND SEVEN HUNDRED ELEVEN DOLLARS &'91 CENTS
RECEIVED FROM
LANDSHAPES NW INC
1151 E 112TH STREET
TACOMA. WA 98445,
253-537-6370
SITE 16205 BIRKLAND ST SE
DATE REC. NO.
07/19/05 37376
AMOUNT
10.711.91 CHECK
REF NO.
2476
BUDGETARY
DIANA
,SEWINS145
WAT ERU 1500, WAT MET 300, CONS DEP 90, TRAF 757.50, BLD FEE 4.50
RECEIPT No.3 7 3 7 7
R8CE!~N THOUSAND FOUR HUNDRED ELEVEN DOLLARS & 83 CENTS
RECEIVED FROM
LANDSHAPES NW INC
1151 E 112TH STREET
TACOMA. WA 98445
253-537-6370
SITE 16223 BIRKLAND ST SE
DATE REC. NO.
07/19/05 37377
AMOUNT
10.411.83 CHECK
REF NO.
2476
BUDGETARY
DIANA
3.99,PLN REV 802 09, MECH 71.75.PLM 90, SEW ERU 5417,SEWINS145
WAT ERU1500, WAT MET 300. CONS DEP 90,TRAF 757 50,BLD FEE 4.50
" , , ,., :,.~~.' ,:...:, THE FACE OF THIS DOCUMENTHAsARED BACKGROUND-NOTAWHITEBACKGR OUND', ":,.,~.,'_,,_r'};f~:=:".,'}' :;.' '. :'
RECEIPT No.3 7 378
BUDGETARY
R8DE*~N THOUSAND TWO HUNDRED FIFTY FIVE
RECEIVED FROM
LANDSHAPES NW INC
1151 E 112ST ST
TACOMA. WA 98445
SITE: 16217 BIRKLAND
BLD-05-0221-YL
DATE
07/19/05
ST SE
DIANA
T71.75, PLMBPRMT90,S/ERU5417. S/INS14
W/ERU1500. W/MTR300, W/DEP40. TRAFF757.50, S/DEP50,STFEE4.50,
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YELM COMMUNITY SCHOOLS
LOCAL RECEIPT DATE -'/)'i/:J~ 19
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25548
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~onhw!m$f[ ,", ~ ~C. 1151 East 112th Street - Tacoma, WA 98445
Office 253 537 -6370 - Fax 253 537 -9163
9
To Whom It May concern.
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InfiltratIon as desIgned on the engmeered plat shall be located III the rear yard of each lot
t;l
~smeyer
PresIdent
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v~ t'&.
,11:' New Construction D Re-Model/ Re-Roof / Addition D Home Occupation Sign q".? ;lV~
D Plumbing D Mechanical D Mobile / Manufactured Home Placement D Other 6' d '-~.
Project Description/Scope o~~ork. ~it~\~-1hmil~ i?0"
Project Value. \\0 S . C1.JO
Building Area (sq ft) ;st Floor lbQ.G 2nd Floor Garage Lj 30
Project Address.
Subdivision .AuturonJ:lULrr.
Basement Carport Patio
# Bedrooms3 # Bathrooms e.. Heating ~JoTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? .JJO If yes, a
completed environmental checklist must accompany permit application
Deck~C
BUILDING OWNER NAME.
ADDRESS \ \,~\.E \ \'2_iYI ~~ 1
CITY1Hl:-W\,(\ STATE V\l[\ zIPt;t~N-\ql:":)
-'"
LICENSE #
EMAIL
TELEPHONE 2--<<;3/ i-j 75 \.~,~ )':L
GENERALCOt:!TRACTOR Ln ~~~D()H 1\\Jf2> 1\1It\i TELEPHONE f)~^')~~1 r"i"!n-( o~ }C)
ADDRESS (\ I,'r:) \ E \ \2 +>>1 5T . EMAIL . .
CITY rr\( i ")rfl{) STATE~r\lf'l ZIP ti((1-ji.-j~';:) FAX 2~')3~ ~:-)"~-J t i I L!J3
CONTRACTOR'S LICENSE # 1I\'Mj)(;\\\.I:'11,e.5iH/EXP DATE~~IT LICENSE #
PLUMBING..C9NTRACJQI3 jlRJ FE <)SKll\\f\i. .VLlHl1fiil/jELEPHONE
ADDRESS PO p) YX 2. ~") EMAIL
g~~~f~~6~'~"~ICENS;:~E ~~~~~~~"~~~~~:;E~ITY LICENSE #
MECHANIC8Lg~NTRAC:rOR i~i\\Y~r: \.IEiHH\!(.l TELEPHONE?\'Y0!Q~...n--qOqf)
ADDRESS 2,) I dl..p 2:6rr 11\ \i t: [:= EMAIL
CITY~'.:;yl\\,:Jh\liW STATE ~\{I\ ZIP Q1{:.:, () I FAX 'J5)~J ~r;'-i1- (l..l:"~-)
CONTRACTOR'S LICENSE #R~MlU.l)W.lii"lt;l. EXP DATE dTY LICENSE # .,
Copy of mitigation agreement with Yelm Community Schools, if applicablec
i herer'- .. ~,~ .L_> >L_ _h_,,_ ;^'^r~~.i...." ;.. "nrr..cl ,ond that the construction_on, and the occupallcy and the use of the
above gton and the
City 0
AP;_Ui2\1 &rblfllrl-&~I~~
Own -2tffiltL&W-lkoi\m' v/ l\b{_\J~c~~
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with ~Q a _CJ1~.s
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lot begun
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1144 FAX
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PIERCt COUNTY
DEVELOPMENT CENTER
t.J\~jC6t-\A~~5 "'ORT H'Nf.:..')l Apphcatlon No
PLEASE COMPLETE THE FOLLOWING:
o /(0'2/ 7 blrKland
2002 WA. STATE ENERGY
CODE INFORMATION
Date
Glazmg area calculatlOn. \tJ Heat system sizing calculation. ~
\33 sf 7 \'?20 sf = % \ ?J?-O X 20 =
Window area 7 Heated floor area = % of glazing Heated floor area x btu per sq ft. = total system output
Refer to the table below to detennine yom compliance path. Divide the system output by the equipment efficiency rating to detennine
the total Btu mput allowed.
JOB TYPE OCCUPANCY COMPLIANCE PATH. HEAT SYSTEM SIZE
~ew MSmgle Family J><fPreQ!)tive Cll. 6 (cIrcle one) lXJ Btu input 'l.. \, \ 'l. 0
[ ] Remodel [ ] MultI-famIly I In m EfficIency rating 'tsD %
[ ] Addition [ ] Component Performance Ch. 5 [ ] WATTS
[ ] System analysIs Ch.4 HSPF ratmg
FUEL TYPE. REA T TYPE ELEC UTILITY PROVIDER.
[ ] Electnc 1>4' Forced AIr Furnace [ ] Tacoma CIty Light
..1>4 Nat. Gas [ ] Heat Pump [ ] Puget Sound Energy
[ ] Propane [ ] Radiant Heat System (baseboard, wall cadet [ ] Penmsula Power
[ ] Oil, wood [ ] Hydronics system p<rOther
[ ] Gas or Wood Stove
VENTlLATION INDOOR AIR QUALITY (VIAQ) INFORMATION (check one)
VentllatlOn OptIOn. [ ]A [ ]B txic [ ]D [ ] AAHX
System SIze' It 00 cfm rxJ Intermittently operatmg [ ] Contmuous operatmg
PRESCRIPTIVE REQUIREMENTSO,J FOR GROUP R OCCUPANCY
CLIMATE ZONE 1- ALL FUEL TYPES
Option Glazing GlazingUcfactor Door 9 Ceiling" Vaulted Wall WaU,mt.4 Wall;ext., 4 Floor 5 Slab
Area to 3 :p 4
U-value ceilillg kbove - Del ow beJowgrade on'
% of-floor grade grade grade
Vertical Overhead
L 12% 0:35 058 0.20 R-38 R-30 R45 R"TS R"IO R-30 R".lO
II" 15% 040 0:58 0.20 R"38 R'30 Re2'1 ~ql RelO Rc30 R-TO
m. Unlimited OAO 0:58 020 R,38 Re30 Rc21 R"21 RelO R-30 R"IO
GiollPR"3
Occullancy
0rily
· Reference Case
o Nominal R-values are for wood frame assemblies orilv or assemblies built in accordance with Section 60 I I
1 Minimum requirements for each option listed. For example, if a proposed design has a glazing ratio to the conditioned floor area of 13%, it shall comply with all
of the requirements of the 15% glazillg option (or higher). Proposed designs which cannot meet the specific requirements ofa listed option above may calculate
compliance by Chapters 4 or 5 of the W.S.E.C
2. Requirement applies to all ceilings except single rafter or joist vaulted ceilings.
3 Requirement applicable to orily to single rafter or joist vaulted ceilillgs.
4 Below grade walls shall be insulated either on the ex1erior toa minimum level of R-JQ or all the interior to the same level as walls above grade. Exterior
lllsula!lOn mstalled on below grade walls shall be a water resistant material, manufactured for its intended use, and installed according to the manufacturers
speCltIcatlOlIS.
5 Floors over crawl spaces or exposed to ambient air conditions.
6 Required slab perimeter insulation shall be a water resistant material, manufacftured for its illtended use, and illstalled according to manufacturer's specifications.
7 lnt. denotes standard framing 16 inches on center with headers insulated with a minimum ofR-5 insulation.
9 Doors, mcluding al ftre doors, shall be assigned default U-factors from Table 10-6C
10. Where a maximum glazing area IS listed, the total glazing area (combilled vertical plus overhead) as a percent of gross conditioned floor area shaJJ be less than or
equal to that value. Overhead glazing with a U-factor of U=O 40 or less is not mcluded m glazing area limitations.
I I Overhead glazing shaJJ have U-factors determined ill accordance with NFRC 100 or as specified in Section 502.1.5
12. Log and solid timber waJJs with a minimum average log thickness on.5 inches are exempt from this insulation requirement
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After recordinl! return to:
Yelm Community Schools District No.2
P O. Box 476
Yelm, WA 98597
Ann: Erling M. Birkland
MITIGATION AGREEMENT
Reference No;
Autumn Hill, Slffi.-04-0036- YL., Yelm. W A
Grantor.
John Lubbesmeycr
Landshapes Northwest, Inc.
1151 E. lI2'h. Tacoma. WA 98445
Gral!lltee:
Yelm Community Schools District No.2
Legal Description:
A 30-17-2E S2 NE NW SE LESS RD
-}
~ c I 307 C(.~
Aslcssor'. Property Tax Parcel Number/Account Number: ~7394-2Q.IOO ;;,17;; .
THIS MITIGATION AGREEMENT ("Agreement") is made this.2!1~ J"n1li- . 2005.
between the YELM COMMUNITY SCHOOLS DISTRICT NO 2. Yelm, Washington ( "District")
Ilnd Landshapes Norhtwest, me.. (the "Developer").
RECJT ALS
A The Developer has submitted an application to ThuJI'Ston County for the construction of a
24 lot subdivision "Autumn Hill IF Yelm, Wash. (the "Project"). The Project is located on property that
hes within District boundaries. more pamcuIarly described on ExhibIt A. attached hereto and
incorporated herein by reference.
B. The State Environmental Policy Act. Chapter 43.2IC RCW ("SEPA"), provides
processes and procedures whereby major actions by stare and local agencies. including, but not limited
to. plat or PUD approval or the issuance of building permits, may be reviewed to determine the nature
and extent of their impact on the environment. Impacts on publIc services. including schools. are
environmental nnpacts for the purposes of SEPA. SErA requ1res the mitigation of adverse
environmental impacts.
C. The District's student population iiZIld growth projections indicate that the Project will
have an impact On the District, when cumulative impacts of other projects are considered.
D. RCW 82.02.020 authorizes the District to enter into a voluntary agreement with the
Developer for payment to mitigate the impact ofihe Developer's PrOject.l
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E. Pursuant to ResoJutlOn No. 12-16-93-05, it is the policy, of the DIStrict to recommend that
the direct impact of development be voluntarily mitigated by the payment of fees and/or other mitigsuon
measures where appropnate.
F The Developer has agreed to mitigate. on a voluntary. basis, the adverse impact of the
Project on the District.
AGREEMENT
NOW, THEREFORE, in consideration of the above recilll6 and the mutual promises and
covenants below, tbe District and the Developer agree as (ollows:
I The Developer acknowledges and agrees that there IS 81 direct impact on the District as a
result of the Developers Project and that this Agreement IS necessary asla result of that impact.
2. The Developer acknowledges and agrees that in order to mitigate the direct Impact of the
Project. the Developer has offered to pay the Distnct the followmg sum of money' Two Thousand One
Hundred Forty and nolI 00 Dollars {$2140.00 for each lot In the subdivtslon or the tolll sum of Fifty One
Thousand Three Hundred Sb.-ty and nol100 Dollars ($51,360.00) (the I'Mitigation Payment") for the 24
lots of the subdivision. The" amount referenced by tlllS paragraph IS subjeca to change pursuant to
paragraph 4 below
3 Any extensiOn. renewal, modification or amendment 1to the Project that results in an
adjustment in the number of lots shall result in a correspondang pro tata adjustment In the MitigatIOn
Payment.
4 The Developer agrees that the payment of the full Mitigation Payment (in the amount of
Two Thousand One Hundred Forty and nollOO Dollars ($2.140.00)1 per dwelling unit or Fifty One
Thousand Three Hundred Si>.'t}I and nollOO Dollars ($51.360.00) for die project, shall be a condition of
building permit issuance for each single family dwelling In the projecti If building permit issuance does
not occur within Five (5) years from the date oflliis Agreement, the amount due for mitigatiOn, as stated
in paragraph 2 above., shall be modified to the amount reflected in i the then most recent mitigation
agreement to which the Distnct is a party A copy of such agreement shall be made llvsJlable to
Developer upon request. ,
5 The District agrees to record this Agreement after it bast been executed by the partlCS.
6. The Developer acknowledges and agrees that the Mitigiltion Payment IS authonzed to be
used for capital improvements to the following facilities: Southworth Elementary School. Mill Pond
Intermediate School, Yew Middle School. and/or Yelm High School and/or any other facilities tbat may
be affected by the Project and/or the purchase of portable facilities and/or school buses.
7 The Developer agrees that the District has five (5) years from the payment date to Spend
the Mitigation Payment for the capital improvements or expenditures ~eSCfibed in paragraph 6. 10 the
event that the Mitigation Payment is not expended within those five years, the moneys will be refunded
WIth interest at the rate applied to Judgments 10 the property owners of record at the time of refund~
however, if the MitigatIOn Payment is not expended within five years due to delay which IS attributable
to the Developer. the Payment shall be refunded WIthout mterest.
8. The Developer waives and relinquishes its right to protest or challenge the payment of
the Mitigation Payment pursuant to this Agreement and hereby coven3!1ts and undertakes that it forever
refrains and desists from instituting. asserting, filing or bringing any Ia.wsult, litigation, claim, or
challenge or proceeding to challenge thIS Agreement, claim any repayment or reimbursement of funds,
perfonnance or improvements provided for therein, or any of its terms and conditions, on any ground or
basis whauDever.
9 The District hereby waives any objection to the Project as presently proposed.
10. The District and the Developer agree mal the Mitigation Payment will be full and
complete mitigation for the impact of the Project as presently proposed Gn the District.
11 This Agreement shall be bIDding upon and mure to thle benefit of the heirs, executors,
administrators, successors. and assigns of both of the Developer and theiDistrict.
o
o
12. Bfan action must be brought to enforce the tenns of thiS Agreement. such action shall be
brought In Thurston Counry Superior Court. The prevailing party shall be entitled to payment of its costs
and reasonable attorneys' fees.
13 This Agreement constitutes the entire agreement betiween the parties and any other
agreement either written or oral shall be null and void.
EXHlBITA
btJ. LEGAL DESCRIPTION
IDi.31
General Location-tG94';, Vancil Rd.. Yelm. WA
Section 30 Township 17N Range 2E
Land Area 5_94 acres
Tax Parcel Number' 227:;94:9 I DfY ~., 30130"100 #J ~
Description: SubdivIsion of 5.94 acres mto 24"sin~le family building lots ..
~
YELM COMMUNITY SCHOOLS DlSTRlCT N . 2
DATED'
s- - 1 7- c r
~G~
By. Alan Burke
Its Superintenden,
STATE OF WASHINGTON )
)SS
COUNTY Of THURSTON )
I certifY that I know or have satISfactory evidence that Alan Burke is the person who appeared
before me, and said person acknowledged that he signed this instrument, on oath stated that he was
authorized to execute the instrument and acknowledged it as the Superintendent of the Yelm Community
Schools Disuia No.2 to be the free and voluntary act of sUl:h party for the uses and purposes mentioned
in the instrument. 1,1..._
GiVEN under my hand and official seal thiS r" day of 2005
....,....',....,',.'''" "
...~ r\eNSA tt"
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.: "'"'~.. EPl~... 7'" I,
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j ~ DO.- ~ -\ ~
ill ;;j : _o,\.,.r.: ':. 'Z ~
so Ii:! f "1fT.....' (J ! ~ :
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, 1"4TE Of ~-~
Ia"\~\,\,,,,,,,,,,.......,,,,
! 0 LJ In and for the Stllle of
mgton, residing at lIe./rY1
My Commission Expires? b-11-~
o
DATED' ~hp>
STATE Of W ASHINOTON )
)SS
COUNTY OF THURSTON )
()
~a;3, ____
. John l..ubbesm~yer -
Its 'l//CC~ ;~//J~
I certify that K know or have satisfactory evidence that Johnl Lubbesmeyer is the person who
appeared before me. ;md said person acknowledged that he signed thisiinstrUmeflt. on oath stated that he
was authorIzed to execute the instrument and acknowledged it as the applicant for this subdivision to be
the free and 'lfolwmry act of slJch party for the uses and JlUJPOses mentIoned an the Instrument.
GiVEN under my hand and official seal this ~ay of . 2005
NO and for the State of
ngtoD. ~siding at Vdry1
My Commissldlll Expires: I' 10- J q -O?1
TOTAL P 05
I
\ REGISTERED !\S.1'!,QV1DED BY LJ\V' !\S
__M"' coN'T €,.?NEAAlJ
\ jcEG1.~1 ~ 11:'41' D~f'\?
9SJi<l1' .' ' LJ\1'll'!S~1.99 ,,1<1'1' 0& /13 i ~~i~'
~~EG:Tj'VE DlkTEO& /P i ZcOOA
LJ'NDS }!!\1'E$l]9RTl"A'lf,$:i;,ttl e-
1151 EhST 112TB STREET
'TA-CQMA- \NA- 9$4:45
\ \ Signature _________ . - rC'
,"",," by OEP ARl'MGNl QF VillO RAND ]]:1DUS I Rlts_
('3197)
[JCkch ?,nd Di,p\"~
Card Before
Plac1l.1g
Billfold
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