BLD-05-0170
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c\1'l Of 'lELtA _ aOIL01",G OEP /l.RltAE"'l
RESIOE"'ll/1.L CER1IfIC/l.1E Of ocCOP /I.",C'l
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Bui\ding p..ddress
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p\an Number
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owner Name
owner J\ddress
Bui\ding permit Number
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specia\ conditions
N\ Code reouired
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RemarKS
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p..reas \ nspected
nate
Bui\ding oHiciat
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. . ,nlern.\\on.' Residenll.1 corle (Cn.pler
,niS struclUre is in conWl1.nce :;:ll~~~:glon 51.,e Building Code Council pursu.nl
5~-5~ Wp..C) as adopted b'lt 2'"'7ea d 70 9Z RCIN e<<eelive JulY j, ZOM
to c,",apters ~9. an I
CITY OF YELM INSPECTION LOG
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PROJECT
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ADDRESS
65- - C>/7 t)
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PERMIT NUMBER
FOOTI,,\;G REBAR
2-D
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7 ./
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/' Date
FOOTfNG
CJ 12"
o 16"
o other
o reqUlred, ents
vii ~ WALL REBAR /~ate '- JAbll(
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WALL
iJ 6"
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SET BACk.S Date
Front
Rear
Slde'Flankmg
Slde
o 8"
o other
C0mme!:ts
COMBI;\ED fRA!\lE/ EXTERIOR SHEAR W .\LL l\SPECTIO~
Hold downs :J Shear NailIng 0
/' -
Frame l LM. ?j'7 Gas'Propane ;i LJlv
Plumbing :J MechanIcal CJ
C Comments
I\Sl LA TlO~
tJ Gas
/7 Foam and Seal
Comments Ol~ 01 ';{J
1 .,
SHEET ROCK/SHEAR \\' .\LL ;\AIL
CJ Electric
~ Vapor barner
!J Other
7 p\,-\
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Comments
OTHER
Comments
fI~AL
o Sewer Final
o Address
[J Electrical
o Insulation
o Cml FInal
o Site DraInage
o Landscape FInal 0 C of 0
!J Slde\\alk.
Comments
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, _ i i'ELI'1 SEL.-IER DEPT
FA><' t-.jO 36121-458-EJ166
Dee ~7 2005 02 40PM Pi
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FAX TRANSlvIISSION
FAX#:
PAGES: I , including this
Cover sheet
CITY OF YELM
\ P.O. BOX 479 - 931 NP ROAD NE
\J YELM, W A 9H597
tx.\U \ 360-458-8411
T' I. FAX 360-458-8166
TO: &RC~Ef..) DATE: J;J. '7-0 ':)
Cf~
COMMENTS: LoT ~ ) ')7~~ 'TELYn 7t:R..~ WA~ 'S.t:.
From: ~f)~OY
Subject: H" t.t-:, E: FiJI! A Ii y~ lW\ ~(U'I
. 5tA -., 6 00
()5- lr
** [1' 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-05-0170- YL
Issue Date 06/15/2005
(Work must be started within 180 days)
Receipt No
37015
AppJJc:3,Ilt:
Name: Evergreen State Builders
Phone:
253-475-6622
Address. POBox 39753
City' Lakewood
State. WA Zip 98499
Pr()perty Information:
Site Address. 15782 Yelm Terra Way SE
Assessor Parcel No 85840009200
Subdivision. Yelm Terra
Lot: 92
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 I nf()rm3,ti()n:
Project: Yelm Terra
Description of Work: 1675/3 Lot 92
Sq. Ft. per floor' (1st) 908
(2nd) 767
(3rd) 0
Garage 413
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 1,149.15 993.75 155.40 5 6000 27 7500 $1,000
Building Plan Review 485 66 0.00 0.00 o 0000 0.0000
Mechanical Permit 78.25 000 0.00 o 0000 0.0000
Plumbing Permit 118.00 20.00 98.00 7 0000 14 0000 Fixture
Sewer Inspection 14500 000 145.00 145 0000 1 0000 ERU
Water ERU 1,50000 0.00 1,500.00 1,5000000 1 0000 ERU
Water Meter (SFD) 300 00 300 00 0.00 o 0000 0.0000
Water Deposit 4000 40.00 0.00 o 0000 0.0000
Traffic Facilities Charge 757 50 000 757.50 750 0000 1 0100 Peak PM Trip
Sewer Deposit 5000 50.00 000 o 0000 0.0000
State Building Fee 4.50 4.50 0.00 o 0000 0.0000
Sewer ERU 5,41700 0.00 5,41700 5,4170000 1 0000 ERU
TOTAL FEES $10,045.06
Applic:allf ~Afl'3,.ctCl,!it
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
Yel~ ~ulations including those governing zoning and land subdivision, and in addition, all covenants,
easem, and restrictions of record. If applying as a contractor, I futher certify that I am currently
registered the State f,Wa5"hington.
\\~\ S
OFFICIAL USE ONLY
# Sets of Prints.
Final Inspection:
Firm
By'
Date: /2. ~ 5/- 6 'i'
-get! '
Date
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Permit Fees Schedule
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant:
Name. Evergreen State Builders
Address POBox 39753
Project Information.
Project: Yelm Terra
Description of Work: 1675/2 Lot 92
Site Address 15782 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
Permit No BLD-05-0170-YL
Phone.
253-475-6622
City' Lakewood
State: WA Zip 98499
Assessor Parcel No 85840009200
Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
-------------
1 149 15 99375 155 40 5.6000 27 7500 $1 000
485 66 000 000 o 0000 o 0000
78.25 000 000 o 0000 o 0000
118.00 2000 98.00 7 0000 14 0000 Fixture
145 00 000 14500 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 o 0000
4000 40.00 000 o 0000 o 0000
757 50 000 757 50 7500000 1 0100 Peak PM Trip
5000 50.00 000 o 0000 o 0000
450 450 000 o 0000 o 0000
5,41700 0.00 5 417 00 54170000 1 0000 ERU
RECEIPT No 37 [] 15
RECI=IVED
*~~*TEN THOUSAND FORTY FIVE DOLLARS & 06 CENTS
RECEIVED FROM
EVERGREEN STATE BUILDERS
P O. BOX 39753
LAKEWOOD WA 98499
SITE 1573~ YELM TERRA WAY SE
BLD-05-0170-YL
DATE
06/15/135
REC NO
371315
AMOUNT
10,1345 06 CHECK
REF NO
PENDING
f"\ aQ .1
U \ 0 ttoU
BUDGETARY
HICHELLE
EDPERIll149 15,PLAN485 b6,HECH73 25,PLUH118 ,SEvlINP145 ,WTEPU1500 ,~'!THET300 ,
WTDEP40 ,TPAFCHG757 50,SEWDEP50 ,STBLDFEE4 50,SEWERU5417 0
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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
# 6074 09 06/15/05
Reg #1 SalesPerson SUSAN
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJECTS
1 @ 1,711 00 1~~~
CK #09869 FOR YELM TERR~_~
SubTotal 1,71100
Total Due
Check
1 ,711 00
1,711,00
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Thank you
PLEASE KEEP THIS RECEIPT' I'
n
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LOT '32
EVERGREEN STATE BUILDERS
/ YELM TERRA
15782 YELM TERRA WAY SOUTHEAST
YELM, WA
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CURB
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WATER LINE
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ST. S~
- - I -(:7l-~
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SEWER LINE
~~ SITE PLAN
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(Q 2004 CASCADE RESIDENTIAL DESIGN, INC
@
NORT~
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
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projeclAddress42ZfZ. /4:.~ ....-~ ,L47-V7
Subdivision: Ye (h/t I'-€r t' tfL Lot #. :7 L Zoning; .,SLlt ~ /t --f{J/h1 / I 'J
~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:~ fJ Ie -raMI '3 &. &t du../-I CL I
Project Value: ;2 / 7. ~..5- 6
.
Building Area (sq. ft) 151 Floor o/~ 2nd Floor Garage ?L/.5 Deck
Basem\mt Carport Patio Z/ b
# BedroomsZ- # BatRi06m~o Heatin~OTHER or ELECTRIC (Circle One)
Are there any environmentalli sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application.
BUILDING OWNER NAME. 'ar
ADDRESS ~~JS/S. EMAll -.s;
CITY L.a.lt1Jtl..iYJd STATE ZIP TELEPHONE
ARCHI1ECTIENGINEE~ 5t?5~ =tl1CENSE #
ADDRESS ,bl ~;;Z "1'1~ EMAllaf.fri~
CITY-;a'ClJrr1a STATE:t'-l/l ZlP<;1x)0Z TELEPHONE(/S3J 2lfY -(3/76
GENERAL CONTRACTOR \'U~ a -S 0'11//1...tr TELEPHONE
ADDRESS EMAll
CITY STATE FAX
CONTRACTOR'S LICENSE # ew EXP OAT . ~ CITY LICENSE #
PLUMBING CONTRAt;rOR..J
ADDRES~~ -<11'InW-
CITY -ra ~. STATE
CONTRACTORS LICENSE #
ZIP
TELEPHONE
EMAIL
FAX Z<~~-9?~
EXP DATE CITY LICENSE #
MECHANICAL CONTHACT9R .~d~~./ //eA'77 .#7 TELEPHONE Z5".5 .G 7o~.? ,xro
ADDRESSSS:u. /.;"',,/'1'" 5r .s/~ -"'1, EMAll
CITY ~,....,.#~ STATE .e'A-"'~ ZIP 7?S'.? 7"> FAX 2:$'3 .s' 7S- efT z.Jrs-
CONTRACTO 'S L1Cf:.NSE # EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable
I hereby certify that the above Information is correct and that the construction on, and the occupancy Bnd the use of the
above described plOperty will be In accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
/~~ Y/7-29S-
.('pplicant's Signaturtt..---- 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 is!;uance, or if work is suspended or abandoned for a period of 180 days
105 Yelm Avenue West
PO Box 479
Yelm. WA 98597
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wa.UB