BLD-05-0176
crN OF YELM - BUILOING OEPAR"fMEN"f
RESIOEN"fIAL CER"fIFICA"fE OF OCCUPANCY
Bui\ding permit Number
~
Lot76
owner Name
owner Address
Ever.....reen s~
~
Lakewood WA 98499
Plan Number
Plan ~6~0 R/2B
Building Address
RemarKs
BLO-05-0~ 66- YL
specia\ conditions
~
oate
oecember ~4 2005
Areas Inspected
Building Official.
G. Carlson
ThiS stlUcture is in compliance with the tnternational Residential Code (Chapter
5\-5\ WI\C) as adopted by tM washington State Buiiding Code council pursuant
to Chapters \9.27 and 7092 RCW. effective JuiY \. 20QA
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CITY OF YELM INSPECTION LOG
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ADDRESS
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/ S 7 3/ to 4 r-/1:/J-ue.- SF~ -
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PROJECT
PER.t\.llT NU!\1BER
SET BACI\S Date
Front ~
Rear 2-t...e
Side Flam.lng -;_
Side ~
FOOTING
~ 12"'
o 16
!J other
o required \ ents
\\' ALL
CJ 6"
o 8"
o other
FOOTl '\G RE B.\ R
Date
\\' .\LL REBAR
D:lle
Corrl.r::ents
CO\lnl~[D FRA~lE/ L\. TERIOR SHEAR W .\LL I\SPECTIO~
Hold downs :J Shear NaIllnl! :=
Frame ;11~\f GasProp,ne- i uAJ
Plumbing .__ !\1echamcal IJ
C Comments-Ahj '\~S b\O~~
I\Sl LATIO~
J Gas
o F oarn and Se3.1
CJ ElectriC
:::! \'3.por bamer
" Other
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Comments
SHEET ROCK/SHEAR \V -\LL \ .\IL
Comments
OTHER
Comments
F1~AL
o Se\\ er Final
~ --\ddress
Q Electnc31
[] Insul3tlon
Q CI\lIFmal CJ L1ndscare Fln:!1 CJ CCifO
o Slte Drainage '1 SIde" all-.
Comments
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32WER DEPT
FRX NO. 360-458-U166
Dee 14 2005 11 41AM P1
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FAX TRANSMISSION
CITY OF YELM
P.O. BOX 479 - 931 NP ROAD NE
YELivl, W A 98597
360-458-8411
FAX 360-458-8166
TO:
DATE: ))- )~/- 0 '")
(,,-{2 E TCJ/ ejJ
FAX#:
P AGES: I , including this
Cover sheet
From: ,Zf1AJ.DY
Subject: 1-1 () US c to 110 fj ~ T to L Y'n -Tcf-f'h
COMMENTS' LoT 70/ / J~7 '3/
)DLI'fJJ. AVE. "'.:"'"> G..-
"'* [1' you do not receive all copies or any copy is not legible, please call (360) 458~8411 ~.
as soon as possible. I:!~,'
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
o
Permit No
BLD-05-0176-YL
Issue Date. 06/28/2005
(Work must be started within 180 days)
Receipt No
37129
Applicant:
Name. Evergreen State Builders
Phone.
253-475-6622
Address. P.O Box 39753
City' Lakewood
State: WA Zip 98499
Property Information:
Site Address. 15731 104th Ave SE
Assessor Parcel No 85840007600
Subdivision. Yelm Terra
Lot: 76
Contractor Information
Name. Evergreen State Builders
Contact: McCullem, Tom
Phone: 253-475-6622
Address. POBox 197
City' Lakewood
State: WA Zip: 98499
Contractor License No: EVERGSB980PB
Expires. 10102/06275
Business License. 1042.0
Project Information
Project: Yelm Terra
Description of Work: Plan 1610 R/2B, Lot 76
Sq. Ft. per floor' (1st) 1610
(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 9715 5 6000 17.3490 $1,000
Building Plan Review 460 90 000 000 o 0000 o 0000
Mechanical Permit 7175 000 000 o 0000 0.0000
Plumbing Permit 111 00 20.00 91.00 7 0000 130000 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 0.00 o 0000 0.0000
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 50.00 5000 0.00 o 0000 0.0000
State Building Fee 450 450 000 o 0000 o 0000
SewerERU 5,41700 000 5.417 00 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.
Signature ./ ~
Firm /S 4
# Sets of Prints.
Final Inspection:
Date
~I~S-
Date:
/'2-1'-/- 0 S
-J,~
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By'
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name: Evergreen State Builders
Address. P.O Box 39753
Projli!ctlnformation.
Project: Yelm Terra
Description of Work: Plan 1610 R/2B , Lot 76
Site Address. 15731 104th Ave SE
F~~s:
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 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 420120-344-85-00
Sewer Deposit 742402-389-01-00
State Building Fee 160001-386-00-00
Sewer ERU 802 412-343-50-01
TOTAL FEES.
Permit Fees Schedule
Permit No BLD-05-0176-YL
3 11)<1
Phone.
253-475-6622
City. Lakewood
State: WA Zip 98499
Assessor Parcel No 85840007600
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
-------------
1,090.90 993 75 9715 5.6000 173490 $1 000
460 90 000 0.00 0.0000 o 0000
7175 000 000 0.0000 o 0000
111 00 2000 9100 7 0000 13 0000 Fixture
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 0.0000 o 0000
4000 4000 000 0.0000 o 0000
757 50 0.00 757 50 7500000 1 0100 Peak PM Trip
50.00 5000 000 o 0000 o 0000
450 450 000 0.0000 o 0000
5,41700 000 5,41700 5,417 0000 1 0000 ERU
$9,948.55
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. .__..__.____._._ .__._._._.____n__.__.____.._____. ___.______.__.__."\
RECEIPT No 37128
RECEIVED
.*~*TEN THOUSAND TWO HUNDRED SIXTY SIX DOLLARS & 03 CENTS
RECEIVED FROM
DATE REC. NO
AMOUNT
REF NO I
PENDING
BUD,;ETAR {
10,266 ,,\:; CHECK
C1 ~~~
EVERGREEN STATE BUILDEP~
3815 100TH ST SW STE 2A
LA~EWOOD WA 98499
BLD-()5-0177-YL
06/2'3/05 J712S
SITE 15734 YEL!-f TEFPA ~-lA1{ SEi
HICHELLE
2LDPI-fT129.1 j::', PLP-.:t'd\EV54::, 96,IiECHPHT':: 75. FLU!lFllT125 '3EVIIN:::'P145 HTEf\U15C''i.J
WTHET300 WAT DEP40 ,TRAFFCHG757 50.SEW DEP 50 ,2TBLDFEE4 50 SEWERERU5417
/
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RECEIPT No, 3 712 9
RECEiVED
*~"'*NINE
TPCU3AND NINE
HUNDRED FOPTY EIGHT
.-------_._~
U""nT,T,AnC;~C;5 r'E'NTe: '"
v.......,........ .!,\:;.; I",...'t -' '-' . o..J "
RECEiVED FROM
EVERGREEN STATE BUILDERS
POBOX 39753
LAKEWOOD WA 98499
BLD-(15-QI176-YL
SITE 15731 104TH AVE SE
DATE REC. NO
AMOUNT
,
,
9.948 55 CHECK !
q;{gl1 J
~
REF NO
PENDING
06/28/05
BUDGETAPY
nrCHELLE
ELDfll'T1090 9(\ ELDFLS-E\i460 YJ,I!EC'HFl!Tll1 OU,:3EHERIN::P145 ~J!'J, \'iTEF.U1S0U
WT![ETERj00 WATDEP4J 00,TRCHG757 50,SEWDEF50 00,ST BLDFEE4 50,SEWERU5417 00
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Yelm School District
ATTN. SUSAN CROY
PO BOX 476
YELM, viA 98597
360-458-1900
Sold 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@8,55V.G8'55500
CK #09891 FOR LOT 7 ,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
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LOT l0
EVERGREEN STATE BUILDERS
YELM TERRA
15731 104th AVENUE SOUTHEAST
YELM, WA
STORM- UNE- -- - - - - - ~ ~ - - ~ - - - - - - - - - --
SEWER LINE- - - -T- - - - ~ - - - - - - - - - - - - - - -- --
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WATER LINE I I
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: 104th AVE. SE :
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cG~ SITE PLAN
,
([) 2005 CASCADE RESIDENTIAL DESIGN, INC
@
NORT~
SCALE \' = 30'
-J
THIS DRAWING IS BASED ON CLIENT-PROVIDED INFORMATION REPRESENTED TO BE ACCURATE
AND RELIABLE, ANY DISCREPANCIES BETWEEN THIS ORAWING AND THE ACTUAL SITE CONDITIONS
ARE THE SOLE RESPONSIBILITY OF THE CLIENT
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ProjectAddress:L(S7.J7 /OY~U6 ~ Pan:et#' ?~/oR/Zff ~ ('.
Subdivision: Ye( r~_ ~ f {cJL lot No, '7/ " J - I' -1/ I ~ ".,
. kgz , Zoning; ~-fl0.t tvHt / f!J '/6'/'\
~ew Construction u Re-Modell Re-Roof I Addition U Home Occupation Sign
U Plumbing U Mechanical U Mobile I Manufactured Home Placement U Orher
Project Oescription!S(:ope of Work: ~ f} Ie. -rattil 0 ee ~j hJ I CL I
Project Value.
Building Area (sq. ft) 1st Floor/~ ,",,0 Zr.d Floor Garage ~ 70 Deck
Basement Carport Patio 2../6
# Bedrooms..3 # Bat/1i~OOms 2. S Heatin~OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER NAME.
AODRESS~-<~
CITY LaA -. _ STATE
ARCHITECTIENGINEE . -S' ,
ADDRESS j) fa. ~? ~
CITY--,a-ciirZ STATE :!:-c/l ZIP 9x.>6 7..
LICENSE #
EMAIL
TELEPHONE
GENERAl CONTRACTOR
ADDRESS .
CITY STATE
CONTRACTOR'S LICENSE # ev.i
PLUMBING CONTRAt;rOR..J
ADDR~~~-~~
CITY fa It. STATE
CONTRACTOR'S LICENSE #
TELEPHONE
EMAIL
FAX .2~-,~~-9~~
EXP DATE CITY LICENSE #
MECHANICAL CONTF~CT9R~s:,H..t-t:'/ #L:'!A-rr #'7 TELEPHONE Z5 J S 7S' ~ ? .J:rc:J
ADDRESSS$'ZG. /f'VY" $''- .s;M 4, EMAIL
CITY ~","8#'~ STATE ~.A-'",,? liP ?A'/75'"" FAX -zS3 "7S- #~rS-
CONTRACTO 'S LICENSE # EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools. if applicable
I hereby cetUfy thlll the lIbove Information Is correct and that the construction on, and the occupancy and the use of the
above described property will be In accordance with the laws, rulell and regulations of the State of Washington and the
City of Yelm.
/~- ~ . S--/J-o~-
Applicant's Signatll~, Date
OWner / Contractor l~ Contractor's Agent (Please circle one.)
All permits are non-t,'ansferabJe and will expire if work authorized by such permit is not begun
within 180 days of liS!;Uance, or if work is suspended or abandoned for a period of 180 days
(360) 458--3835
(360) 468--3144 FAX
www.ci.yelm.wa.U8
105 Yelm Avenue West
PO Box 479
Yelm. WA 9859'1