BLD-05-0177
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C\1'f Of 'fE\.tA _ BUI\.OING OEPARitAENi
RESIOENiIA\. CERilflCA iE Of OCCUP ANC'f
euilding p.ddress
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plan Number
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owner Name
owner p.ddress
euilding permit Number
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p.reas Inspected
special conditions
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RemarKS
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Date
euilding Omcial
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. . I le'natiOnal Residential Code (Chapte'
1hiS strUclU,e is in compliance ~\th ~e ; n State Building Code council pursuant
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CITY OF YELM INSPECTION LOG
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PER.'llT NUMBER () S -o! 7 '7
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Hold downs :J Shear NaJlInl.!. CJ
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0177 - YL
Issue Date. 06/28/2005
(Work must be started within 180 days)
Receipt No. 37128
Applicant:
Name. Evergreen State Builders
Phone.
253.475.6622
Address. 3815100th St. SW, Ste. 2A
City' Lakewood
State: WA Zip 98499
Property Information:
Site Address. 15734 Yelm Terra Way SE
Assessor Parcel No. 85840008600
Subdivision. Yelm Terra
Lot: 86
Contractor Information
Name: Evergreen State Builders
Contact: McCullem, Tom
Phone: 253-475-6622
Address. POBox 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 2211/2, Lot 86
Sq. Ft. per floor' (1st) 1071 (2nd) 1140 (3rd) 0 Garage 434 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 1,299 32 993.75 305 57 5.6000 54.5660 $1,000
Building Plan Review 548.96 000 0.00 o 0000 o 0000
Mechanical Permit 78.75 000 000 0.0000 o 0000
Plumbing Permit 125 00 20.00 1 05 00 7 0000 15.0000 Fixture
Sewer Inspection 145.00 0.00 145.00 145.0000 1 0000 ERU
Water ERU 1,50000 000 1,500.00 1 500 0000 1 0000 ERU
Water Meter (SFD) 300 00 300 00 000 0.0000 o 0000
Water Deposit 4000 40.00 000 0.0000 o 0000
Traffic Facilities Charge 757.50 0.00 757.50 7500000 1 0100 Peak PM Trip
Sewer Deposit 5000 5000 0.00 o 0000 o 0000
State Building Fee 450 450 000 o 0000 o 0000
SewerERU 5,41700 000 5,417 00 5,4170000 1 0000 ERU
TOTAL FEES $10,266.03
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 4'S'A5
D,le ~~S-
Final Inspection:
Date. /1---2.. J- ()S~
rJ!N-
By'
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Permit Fees Schedule
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Appl~ant:
Name: Evergreen State Builders
Address. 3815 100th St. SW, Ste. 2A
Project Information.
Project: Yelm Terra
Description of Work: Plan 2211/2, Lot 86
Site Address. 15734 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 420120-344-85-00
Sewer Deposit 742402-389-01-00
State Building Fee 160001-386-00-00
Sewer ERU 802412-343-50-01
TOTAL FEES
Permit No BLD-OS-0177-YL
3lld~
Phone.
253.475.6622
City' Lakewood
State: WA Zip 98499
Assessor Parcel No. 85840008600
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
-----------..-
1,299 32 993.75 305 57 5.6000 54 5660 $1,000
548.96 000 0.00 o 0000 o 0000
78.75 0.00 000 o 0000 o 0000
125 00 2000 105.00 7 0000 15 0000 Fixture
145.00 000 14500 145 0000 1 0000 ERU
1,500 00 000 1,500.00 1,500 0000 1 0000 ERU
300 00 300.00 000 o 0000 o 0000
4000 4000 000 o 0000 0.0000
757.50 0.00 757 50 750 0000 1.0100 Peak PM Trip
5000 5000 0.00 o 0000 0.0000
450 4.50 000 o 0000 o 0000
5,417 00 000 5,41700 5,417 0000 1 0000 ERU
$10,266.03
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RECEIPT No 37128
RECEIVED
~"';-"TEN
THOUSAND
TWO HUNDRED ~IXTY SIX
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lA;~~~T6J 3 ~~
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REF NO I
PENDDJGI
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RECEIVED FROM
fA ~A~~ Q ! ~ _ R~~/' ~~ ~.
'/-101 ~ J/ (")~ _' ,~.::..G
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BUDGETARl
EVERGREEN STATE BUILDEPJ
:,815 100TH ST SW bTE :A
LAKEWOOD WA 98499
2LD-I2J5-0177-'YL
SITE lS73~ YE1~1 TEFRA
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HICHELLE
BLDPHT12':;1 =~::',PLANEEV54;:, :~G,HECHPI!T':: "'5,FLUHFl!Tl:::'5 ':iEVIINSP145 l'ITEE.J1500
H T 11 E T j 0~) vI AT DE P 4 -:} , T H A f f C H G 7 5 7 5 0 , S E \-/ DE P 5 () ,S T B L D FEE 4. 5 0 ~~ ENE R E R U 5 4 1 7
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RECEIPT No 37129
RECEIVED
*~**NINE THOUSAND NINE HUNDRED FORTY EIGHT DOLLARS & 55 CENTS
RECEiVED FROM
EVERGREEN STATE BUILDEPS
P (; BOX 39753
LAYEWOOD WA 98499
BLD-05-'2l176-YL
SITE 15731 104TH AVE SE
DATE REC NO
06/23/05 37129
BUDGET.1l.RY
AMOUNT
9.948 55 CHECK
q~g(1
REF NO
PENDING
HICHELLE
BLDPMT1090 90 BLDFL~EV4b0 Q0,MErHFIIT111 OO,SEWERIN2P145 00, WTERU1500
i'l T![ E T E R ..:) 0 0 W\ T DE P 4 -J 0 ,~) , T R C H G 7 5 7 50, SEW DE P 50 00, S T B L D FEE 4 50, S E HER U 5 4 1 7 00
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Yelm School District
ATTN SUSAN CROY
PO BOX 476
YELM, vJA 98597
360-458-1900
So 1 d to. 16755
EVERGREEN STATE BUILDERS LLC
56622
BUILDERS LLC EVERGREEN STATE
5516 75TH ST W #1
LAKEWOOD, WA 98499
# 6164 10 06/28/05
Reg #1 SalesPerson SUSAN
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJECTS
1 @ 8,555 0069,555 00
CK #09891 FOR LOTS 76 6, 1,96,97/YELM T
ERRA
SubTotal
8,555 00
Total Due
Check
8,555.00
8,555.00
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Thank you.
PLEASE KEEP THIS RECEIPT I I I
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LOT 80
EVERGREEN STATE BUILDERS
YELM TERRA
15734 YELM TERRA WAY SOUTHEAST
YELM, WA
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YELM TERRA WAY
___L__________________________
STORM LINE
~~ SITE PLAN
-~ - /'
_____._...-~-L----.--.-
,
@ 2005 CASCADE RESIDENTIAL DESIGN, INC
@
NORTH
SCALE I' = 30'
THIS DRAWING IS BASED ON CLIENT-PROVIDED INFORMATION REPRESENTED TO BE ACCURATE
AND RELIABLE. ANY DISCREPANCIES BETWEEN THIS DRAWING AND THE ACTUAL SITE CONDITIONS
ARE THE SOLE RESPONSIBILITY OF THE CLIENT
--~
Project Address:&:Z"s.e/.... r-i'-<<-<:", _y ~ It 9..1// M
Subdivision: Yeff.vttirrdL Lot'- ,ff~ Zoning; SiA1~ I.p --fCM71, I':)
~ew Construction U Re-Modell Re-Roof I Addition U Home Occupation Sign
U Plumbing u Mechanical U Mobile I Manufactured Home Placement U Other
Project Description/Scope of Work: ~ f} Ie -fa/h11 01 R.t. &t du-/-I CL I
Project Value. ~.;( .? ~ ~O
Building Area (sq. ft) 1st Floor /(!)7/ 2nd Floor//~GS1 Garage Deck
Basem~nt Carport Patio Z/6
# Bedrooms 4 # Batn~06ms Z 6 Heatin~OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checkjist must accompany permit application.
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BUILDING OWNER NAME: 'air
ADDRESS ~~i5/5 - EMAlL '-Sj
CITY L.t:Ut.tJtvYYJd STATE ZIP TELEPHONE
ARCHITECTIENGINEER.~-S~ :.oIl.JCENSE #
ADDRESS h L ~;;Z 17.~ EMAILal..kj~_
CITY72lClJrila STATE t:~ ZlP<;1,f~Z TELEPHONE(IS'3J 2lfY -t5/76
GENERAL. CONTRACTOR I.~ a.s trJ1/Ittr TELEPHONE
ADDRESS EMAIL
CITY STATE FAX
CONTRACTOR'S LICENSE # eV.ei EXP OAT . (Z CITY LICENSE #
PLUMBING CONTR&;rOR,.j
ADDRES~~ -~~
CITY 7a It. STATE
CONTRACTORS LICENSE #
TELEPHONE
EMAIL
FAX Z<~~~-9?~
EXP DATE CITY LICENSE #
MECHANICAL CONTRACT9R .-s;,d~l:'"/ #e'A77 #7 TELEPHONE Z5..; .B 7o~? ,7:5'0
ADDRESS5SzG:. /~..."/~ 5r .sr~ -1/, EMAIL
CITY "';;J"c!?//~ STATE ~.AY' '$? ZIP "fI~? 7S- FAX "ZS'3 .# 7S- Q' z.x:'s-
CONTRACTO 'S LICENSE # EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable
I hereby certify that the above Information 15 correct and that the construction on, and the occupancy and the use of the
above described property will be In accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm,
./ ~_ --- _ J~/J~c;/6-
Applicant's Signaturt~ Date
Owner I 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 if work is suspended or abandoned for a period of 180 days
105 Yelm Avenue West
POBmc 479
Yelm. WA 98597
(360) 458--3835
(360) 458-3144 FAX
www.ci.yelm.wa.UB