BLD-05-0185
~-~--
CI1'f Of '{ELM- 6UILOltlG OEP ~R'TMEtl'T
RESIOEtl'TI~L CER'TlfIC~ 'TE Of ocCUP ~tlC'{
eui\din9 Address
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~
p\an Number
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O\Nner Name
O\Noer Address
eLO~05-0'\ 85~'(L
eui\din9 permit Number
RemarKs
---
N\ Code renuired
~
Neas \ns~ected
oate
s~ecia\ conditions
eui\din9 Ofticia\
~
. . \olernaliooa\ Resideotial code (Chaplel
.his SllUctule is io COfllP\laoce :::,\I~~~: 100 stale Buildi09 Code couocil pursuaot
5 '\ ~5 '\ \N AC) as ado~ted b'Jt 2n1e ~ 10 ~2 RCIN eflecti,e Julj \. 200A
to cna~ters '\9. anu '
~~~!
~ROM YELM SEWER DEPT
FAX NO 360-458-E3166
Dec. 09 2005 12 29PM P1
FAX TRANSJvIISSION
CITY OF YELM
P.O. BOX 479 .~- 931 NP ROAD NE
~ YELM, W A 98597
r \n ' 360-458..8411
U \X, \\. . FAX 360-458-8166
TO. &- /Z...ctH E",u
D A IE: I J.. - 7 - () ':)~
FAX#:
PAGES: I, including this
Cover sheet
From: R,.q^yO~
Subject' HOl..\st: f:INALJ'ieLWl 1CtW.A
COMMENTS: L DT '11 ) ~:f 7710
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J ELw) "TER.'(A ~f}Y
05-59/0 .OrJ
** If you do not receIve all copies or any copyS not legible, please call (360) 458-8411
as soon as possihle
In
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0185-YL
Issue Date. 06/28/2005
(Work must be started within 180 days)
Receipt No
37127
Applicant:
Name: Evergreen State Builders
Phone.
253-475-6622
Address. POBox 39753
City' Lakewood
State: WA Zip 98499
Property Information:
Site Address. 15776 Yelm Terra Way SE
Assessor Parcel No. 85840009100
Subdivision. Yelm Terra
Lot: 91
Contractor Information:
Name. Evergreen State Builders
Contact: McCullem, Tom
Phone: 253-475-6622
Address. P.O Box 39753
City' Lakewood
State: WA Zip 98499
Contractor License No. EVERGSB980PB
Expires. 10/02/06275
Business License. 1042.0
Project Information:
Project: Yelm Terra
Description of Work: Plan 1819/2, Lot 91
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 1,282.71 993.75 288 96 5 6000 51 6000 $1,000
Building Plan Review 542.02 0.00 000 o 0000 o 0000
Mechanical Permit 8475 000 000 o 0000 o 0000
Plumbing Permit 132.00 20.00 112.00 7 0000 160000 Fixture
Sewer Inspection 14500 0.00 145.00 145.0000 1 0000 ERU
Water ERU 1 500 00 0.00 1,500 00 1,500.0000 1 0000 ERU
Water Meter (SFD) 300 00 300.00 000 0.0000 o 0000
Water Deposit 4000 4000 000 0.0000 o 0000
Traffic Facilities Charge 757 50 000 757 50 750 0000 1 0100 Peak PM Trip
Sewer Deposit 5000 5000 000 o 0000 o 0000
State Building Fee 4.50 4.50 000 o 0000 o 0000
Sewer ERU 5,41700 000 5,41700 5,417 0000 1 0000 ERU
TOTAL FEES. $10,255.48
Applicant's Aftadavit:
OFFICIAL USE ONLY
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record If applying as a contractor, I futher certify that I am currently
registered in the State of Washington.
Signature / ~4-
frd
# Sets of Prints.
Date
~..k'"
/
Final Inspection:
Date: I 2. -$/- Os-'
Firm
By'
-f1L
Applicant:
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Permit Fees Schedule
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Name: Evergreen State Builders
Address. P.O Box 39753
Project Information:
Project: Yelm Terra
Description of Work: Plan 1819/2, Lot 91
Site Address. 15776 Yelm Terra Way 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 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 420120-345-85-00
Sewer Deposit 742402-389-01-00
State Building Fee 160001-386-00-00
Sewer ERU 802412-343-50-01
TOTAL FEES
Permit No BLD-05-0185-YL
3'11dl
Phone:
253-475-6622
City' Lakewood
State. WA Zip 98499
Assessor Parcel No. 85840009100
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
-------------
1,282.71 993 75 288.96 5.6000 51.6000 $1,000
542.02 000 000 o 0000 o 0000
8475 0.00 000 o 0000 0.0000
132.00 2000 112.00 7 0000 16 0000 Fixture
145.00 000 145.00 145.0000 1 0000 ERU
1,500 00 0.00 1,500 00 1 500.0000 1 0000 ERU
300.00 300 00 000 o 0000 0.0000
4000 4000 0.00 o 0000 o 0000
757.50 0.00 757.50 750.0000 1 0100 Peak PM Trip
5000 5000 0.00 o 0000 o 0000
4.50 450 000 0.0000 o 0000
5,41700 000 541700 5,417 0000 1 0000 ERU
$10,255.48
C~BE:"'~~~~"~~~~~~""~~~'''TlIII~
~~~~~~:~~~~1lli~~~=>- _ - . ( IDe . -. .. D;;' .. e e -_>"~ t, ';1 ;: , .. e '_\l~~~~~_;,"~1~~1~ : -~lt*~~lj
c f~~{1iaF .-- ~-'___._c_ ~.... -.~-'. --. -, . C_,-,._C. _C..n.' "'- -.'~ . . .cCC.' .--.-- Oc""'-. CCC=-'". -.' .'
/':/' ~
/ / POBox 479
Yelm WA 98597
360-458-8403
RECEIPT No 37125
-'F~-IVFP.
r_ f-._
. 'h ~. 'EN THOLlSAND FOR'I'Y FIVE DOLLA.RS & 06 r'::l:~NTS
RECEiVED FROM
DATE
REC NO
AMOUNT
REF NO
EVEPGREEN STATE BUILDERS
05!::'?/Q)r:.; 37125
10~045 e,G C}iECh
FENDIN1_,
P (I BOX 39753
LA}EWOOD ~A 9?499
BLD-('l5-0171-YL
~ITE 15322 YELM TERPA WAY SE
EUDGETARY
q ~gLl
HI CHELLE
B L D ? E R II 11 4 ;:-, 1";, P L D f L F E ,[ 4 ,S" 6 G, 11 E C H Hf T 7 E .2 ~, P L L1 H F 11 T 11: .': h nI;].f 1 4 ~ ,
WFTERU1500 ,WTHET?0C 0 WTDEP40 ,TFFCHG757 50,SEWDEP50 ,STBLDFEE4 50,SEERU5417
- .... ~
._.._..__ ~_,__.__.___.___._______._..__ _.__.___ __ __.____._._.____u__.___.__.__ _.______.___"____ _.._._..__ _~_._,_._._.._ .-.-.-----~.~.--...-,-.-~..._.- --...--..--- - _.~ -..----..--.--~-..--- -
~11 C{1rSF
~~ PO Box 479
Yelm. WA 98597
o ..YE~2~!L.. 360-458-8403
RECEIPT No 3 7126
RECCIVFD
<;'1<.. "'rEN THOUSP,ND THIRTY EIGHT DOLLARS .'Y. 41 CENTS
F:ECEIVED FROM
DATE
REC NO.
AMOUNT
REF NO
EVEFGPEEN STATE BUILDERS
06/~8/05 ::'7126
?215 100TH 3T SW STE 2A
LAKE WOOD WA 33439
ELD...i2}j--0172..-YL
15816 YELM TERFA WAY SE
BUDGE'I'F..EY
1.0.038.41 CHEn
c\ ~ ~Cl
FEN D I !~ G
HIChELLE
E L D t H T 11 4 3 1 5 . F L F' E v 4 t c 5 1 , 11 E C H Hi T 7 g 7 5 , FLU 11 P! 1 T 1 11 ;:, E in N S P 1 <J 5 ,viR T E r-: U 1 5 (;, c:
WTMET~00 ,WTCE?40 TRAF757 50,SEWDEPS0 ,~TBLDFEE4 ~0,3EW ERU 5417 00
/
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"' 0 ~ .""".; 0
..
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. .
RECEIPT No 37127
BUDGETP,HY
4E
REF NO
REQf=lv'-n
~*~~EN THOUSAND TWO HUNDPED FIFTY FIVE DOLLAFS
RECEIVED FROM
EVERGREEN STATE BUILDERS
P n BlX 39753
LAfEWOOD WA 98499
3LD-05-i.)185-VL
SITE 15776 YELH TERRA WAY SE
DATE REC NO
06/:8/05 37127
PENDING
J1ICHELLE
BLrPEPl:S'::' 71,BLDPLREV54," 02,ifECHPl1TS4 7~;,FLU!h-;F\'I'L2 ,SEViINSP145 ,\;PTEt:;[Jl~iun
I'iF:TllET::::J0 ,hRTDEP4C1 ,TL'1fCHG757 so SEVlDEE~0 ,STBLDFEE4 50,SEldEHU5417 00
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Yelm School District
ATTN SUSAN CROY
PO BOX 476
YELM, vlA 98597
360-458-1900
Sold to: 16755
EVERGREEN STATE BUILDERS LLC
56622
BUILDERS LLC EVERGREEN STATE
5516 75TH ST W ~1
LAKEWOOO, WA 98499
~ 6164 10 06/28/05
Reg #1 SalesPerson SUSAN
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJECTS
1@8,55500&!J.5500
CK #09891 FOR LOTS 76,86 91 96,97/YELM T
ERRA
SubTotal
8,555 00
Total Due
Check
8,555 00
8,555 00
----------
----------
Thank you
PLEASE KEEP THIS RECEIPT' I I
05/09/2005 15 05
2532843183
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CAS RES NWAF TDM
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LOT ~1
EVERGREEN STATE BUILDERS
YELM TERRA
YELM, WA
PAGE 02/05
~JJJ PLAN APPROVAl:,
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WATER LINE I . ~
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SEWER LINE -----,---------
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. SITE PLAN
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~ 2004 CASCADE RESIDENTIAl,. DESIGN, INC
@
NORT~
SCALE I' : 30'
THIZ ORAWINO IS MsED ON CLl~NT-PROYIO~o l~rORMATION REPRESENTED TO BE ACCURAH
AND RWASLc. ANY OI5CRF.PANCIES gnWEEN THIS ORAWINr, AND THE ACrUAL 51t. CONPITIONS
ARt. tHe, 501,[ RCSrON~leILlT\' OF THr, or.leNT,
n ,P~ CJ . /
ProjectAddraSs:452'~. ych q,eIi#!A ~~~ice.#'.___~/70/2 ____
SUbdiViSion;~J!!t I.€r ~~ l.ot #'_fL~~ ZOning; .~ut o/l --1{f11tJ...! ~
'~ew Construction U Re--Modell Re-.Roof I Addition U Home Occupation Sign
u Plumbing u Mechanical U Mobjle I Manufactured Home Placement U Olher
Project DescriP$nJSCOpe of Work:~t!}-'e -ft.,(/W.~e~,( dlJJi.l (t:L I
Project Value' '.J .d~1 ?~ __.__._
Building Area (sq ft) 181 Floor..t:.i~ 2'10 Floor.~"_ Garage....ff..() Deck
Basement Carport_.__Patio~~~
# Bedrooms-1... # 8athroornsQ5 Hea!in~)THER or ELECTRIC (Circle One)
Are there any environmentally s~nsitive areas located on the parcel? _ If yes, a
completed environmental checklist must accompany permit application
BUILDING O~E~ N~ME~=~;T-- p-/f7 I f~S!i!l'e_l:?Zjj 1(/a~'tH'S . ; , -]
AODR~~S~-1g IS -:::::. '1t \ ""' j '_ ~ EMAll...6- S' ~ _, ""~tl.~:Ji.
CiTY~. ~TE IIPr.:-~' 2-T~H~==;: -==~ _
ARCHITECT~~E~~f;k~~tl,;iiggfllCENSE C_ ~ . )
~~~~~tii~ :~-~~/T~r~~~~~~~ ;~k'-(~>;6-
GENERAl. CONTRACTOR. ...W/IIJ((,t/ ci---:S~WLt!fy TELEPHONE__~ -
ADDRESS._ . ~~_. _~.EMAll_
CITY STAlE ZIP FAX .
CONTRACTOR'S UC~SE #~/J 1~i5<~r~Ci~ .L.tCENSE # :_
:;tt::~;/~~~~/Jl~~~t-lONE~2~37-I\'~O
Cnvla({iiYJ1 _-=-STATE . zfP1jr~?-'-FAX. ;ZS-,:s$~~~ __
CONTRACTOR'S lJ~E~.!-=.=___.~_;::. EX? DATE_~.L1CENSE #
rMECHANICAt.. CONTRACTOR~....."..niEPHONE. . -. 0
I ~OORESS____ __ ______EMAiL ._._____._
I CITY STATE ZIP FAX
I CONTRACTOR'S LICENSE '-.__.. w. _ EXP DA TE._.__._CITY LlCEfJSE _# ~..~.__
::: I
___ Copy of mit/nation agreement with Yelm Community Schools, if applieablG
thereby certH" thot the IIllO\l1l Infurmat!orl till COn'llCt IIlld thm the cOl'lstructfon on, lIf1d Ine oecupa,lCy and the use of tlu!
above described property will 00 In accord:llfll:s wIth the IIIW8. mllllllitnd r~gulutlnos of the StIlJte of W119hlngtlln and the
City of Ylllm.
/~~ ~___' d>-/,f-o-$.-
Applicant', SignaturJ_._...--------__... Date
Owner / Contractor ( Owner's Ag~ Contractor's Agent {Please circle one.J
-------
All permits are non~transferable and win expIre if work authc:u'i:t&d by such permit is not begun
within 180 days of issuance, or If work is suspended or abandoned for a period of 180 days
loti Yel". Avt!l1ue We8t
PO Box 479
Yelm,. WA NNJif}'1
(860) 458-3836
(31;0) oItJlJ-.3144 FAX
llJww.ci,,,,"lt1l.wa. WI