BLD-05-0179
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CITV OF VELM - BUILDING DEPARTMENT
RESIDENTIAL CERTIFICATE Of OCCUPANCY
15719 104th Ave SE.
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Lakewood WA. 98499
Plan Number Plan 1610R/2B Lot 78
BLD-05-0179-YL
Building Permit Number
Remarks
Areas Inspected
special conditions
Building Official'
All Code reQuired
March 13 2006
Date
G Carlson
This stfUcture is in compliance with the tnteroational Residential code (Chapter
51-51 WI<C) as adopted by the washington State Building code Council pursuant
to Chapters 19 27 and 70 92 RCW, effective July 1, 2004
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CITY OF YELM INSPECTION LOG
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PROJECT
PER.~llT NUMBER
ADDRESS
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FOOTING
~ 12"'
o 16"
~ other
o reqUired, ents
WALL
~ 6"
o 8"
o other
SET BACKS D3te
Front ~
Rear 'Z-LR
SJdeFbnk.mg
SIde
FOOTI'G REB.\R
Date
\\' .\LL REB.\R
D:lle
Comments
CO\lBI:\ED FRA;\lE/ EXTERIOR SHEAR \\' -\LL I\SPECTIO~
Hold downs ::J Shear NadIng ~
Frame ~ 11- '2...7 ..(Q:J G3S 'Propane Y
Plumbmg :3" (I, 'l.'1 ,Jf1J.. !\1echan1cal ~ /l-'2.j -:NL
C Comments
I'\Sl LA TIO~ J Gas
\
fl, z..~ ~ Foam and Seal
~ Electflc
~ \' apor balTler
n Other
~ PV;
Comments
SHEET ROCK/SHEAR \V .\LL '.\IL
Comments
OTHER
Comments
Fl~ .\L
o Se\\er Fin31
[] l~ddress
Q Electnc31
[] InsubtJon
Q CI\ 11 FIn31
o SIte DraIn3fe
~ bndsc3pe FIn3!
'I Slde\' 31l
n CClfO
Comments
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FROM YELM SEWER DEPT
FAX NO 360-458-(3166
Mar 07 2006 05 04PM Pi
FAX TRANSMISSION
CITY OF YELM
P.O. BOX 479 - 931 NP ROAD NE
f \ YELM, WA 98597
I \~ IX R'\ 360-458-8411
\CJ ~\ FAX 360-458-8166
TO: G-REYH~;J DATE: )-)-0<"
FAX#:
PAGES: I , including this
Cover sheet
From: KJ,J-.H) Y
Subject: 14 6 U 3 E l=- l1J f-.) L sly
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COMMENTS: LOT "7 1/ 1<)1, q ) tJL/ W- AJ~ S. C
La! 9'~~ 15<rlo ~ELhl ~) _DO/'!
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\ Ci5 - j9S{) C(;
.. If you do not receive all copIes or any copy IS not legible, please call (360) 458-8411
as soon as possIble
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360)458-3144
Permit No
BLD-05-0179-YL
Issue Date 09/23/2005
(Work must be started within 180 days)
Receipt No
38323
Applicant:
Name. Evergreen State Builders
Phone.
253.475.6622
Address, 3815 100th St. SW, Ste. 2A
City' Lakewood
State: WA Zip 98499
Property Information:
Site Address, 15719 104th Ave SE
Assessor Parcel No. 85840007800
Subdivision: Yelm Terra
Lot: 78
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 1610R/2B, Lot 78
Sq, Ft. per floor' (1 st) 1670
(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 1,090 90 993 75 305 59 5.6000 54 5700 $1,000
Building Plan Review 460.90 000 000 0.0000 o 0000
Mechanical Permit 7175 000 0,00 o 0000 o 0000
Plumbing Permit 111 00 20,00 9100 7 0000 13.0000 Fixture
Sewer Inspection 14500 000 14500 145 0000 1 0000 ERU
Water ERU 1 500 00 000 1 500 00 1 500 0000 1 0000 ERU
Water Meter (SFD) 300,00 300 00 000 o 0000 o 0000
Water Deposit 4000 4000 000 0,0000 0,0000
Traffic Facilities Charge 757.50 000 757 50 750,0000 1 0100 Peak PM Trip
Sewer Deposit 5000 5000 000 o 0000 0,0000
State Building Fee 4.50 4.50 000 o 0000 0,0000
Sewer ERU 5,41700 000 5,41700 5,417 0000 1 0000 ERU
TOTAL FEES $9,948.55
Applicant's Affadavit:
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,
# Sets of Prints.
Signature/,;'~~___~
Firm ......... .I
"..,."t1f;7 .
Date ?- rZ-4II2r
Final Inspection:
'3',/3-. (-, /-
Date: ~
rjIj,
By'
Applicant:
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Name. Evergreen State Builders
Address, 3815 100th St. SW, Ste. 2A
Project Information:
Project: Yelm Terra
Description of Work: Plan 1610R/2B, Lot 78
Site Address. 15719 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
032001-322-10-00
Sewer Inspection
Water ERU 715401-343-80-02
805 412-343-80-00
Water Meter (SFD) 712401-343-80-01
Water Deposit 740402-389-00-00
Traffic Facilities Charge 420 120-345-85-00
Sewer Deposit 742402-389-01-00
State Building Fee 160001-386-00-00
Sewer ERU 802412-343-50-01
TOTAL FEES.
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PAID
SEP 2 j 2lJ[)j
CiTY OF YEW
City' Lakewood
Permit Fees Schedule
Phone:
Permit No BLD-05-0179-YL
Kec- 3~3~3
State: WA Zip 98499
253.475.6622
Assessor Parcel No. 85840007800
Item Fee Base Amt
1,090,90 993,75
460 90 000
7175 000
111 00 2000
145.00 000
1,500 00 000
300 00 300 00
40,00 4000
757,50 0,00
5000 50,00
450 450
...
5,41700 000
$9,948.55
Unit Fee
305.59
Unit Rate No, Units Unit Desc
000
000
9100
145.00
56000 54,5700 $1,000
o 0000 0 0000
7 0000
0,0000 0 0000
145 0000
1,500,00 1,500 0000
0,00 o 0000
000 o 0000
757,50 750,0000
000 0,0000
000 o 0000
5,41700 5,4170000
13,0000 Fixture
1 0000 ERU
1 0000 ERU
o 0000
0,0000
1 0100 Peak PM Trip
0,0000
o 0000
1 0000 ERU
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RECEIPT No 3 8 3 2 3
RECE! lED
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RECEiVED FROIVi
DATE
REC I\JO
AMOUNT
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RECEIPT No 38324
I~EC~l lED
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F:ECEIVED FFlClM
DATE
REC NO
AMOUNT
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Yelm Community Schools
PO Box 476
Yelm, WA 98597
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Clerk. C
Termina 1: ray
Receipt: l6
Manual Receipt: 94
EVERGREEN
DISTRICT OFFICE
EVERGREEN STATE, BUILDING LLC
9/23/2005 2:17 PM
Qty Item
1 CPF2900
MITIGA TION
YELM TERRA LOTS 75,78,82
Subtota 1 :
Tax:
Tota 1 :
Check
10424
Amount Due.
Price
5133.00
5133 00
0,00
5133 00
5133.00
0.00
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Yelm Community sc(~
PO Box 416 ~. '
Velm, WA 98591 --==----,
Clerk: Cray
Terminal: 1
Receipt: 4693
Manual Receipt:
EVERGREEN
DISTRICT OFFICE
EVERGREEN STATE, BUILDING LLC
9/23/2005 2'16 PM
Qty Item
1 CPF2900
MITIGATION
YELM TERRA DEVELOPMENT
Subtotal:
Tax:
Total:
P rice
13688 00
13688.00
0.00
13688.00
Check 13688 .00
10405 LOTS 6,7,9,10
, 11 ,34,35,36
Amount Due.
0.00
09/15/2005 17 00
2532843183
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CAS RES N~~TDM
PAGE 10
LOT l8
EVERGREEN STATE BUILDERS
YELM TERRA
16719 I04th AVENUE SOlrrHEAST
YELM, WA
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lHI5 ORAWI~G IS eA~[O D~ cLl~NT-PROVlnf.D IN~MMATIO,J RF.PR~SF.NTfO TO RE ACCV~AT[
AND RElIAeLF.. ANY DISGR~PANCI!:S "ETWrEII T,,'S DRAWINO ^ND THr. AGTU^l sirE CQNDITIONS
ARE TH[ SOI.F. RtSPON~1011.ITY OF 1H~ CLIENT
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