BLD-05-0168
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crf'l Of 'lEL~ _ BUILOING OEP ARi~ENi
RESIOENilAL CERilflCAiE Of OCCUPANC'l
Building p,ddress
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Building permit Number
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Plan Number
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owner Name
owner A.ddress
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A.reas Inspected
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Remar'Ks.
special conditions
oate
Building oHiciat
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. . Ih I I tonal Residenl'al Code (Chapler
lnis structure is in compllancewwltn h' e .n ernstaat1e Building Code Council pursuant
51 W"C) 5 adopted b~ lhe as",Oglon
51- I~ Chaplers 19.27 aod 70 92 RCW, effect,ve JUlY 1,2004
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CITY OF YELM INSPECTION LOG
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PROJECT ll!.)1N1 'iu /'0-) 1.0 f 3-;
PER.t-..llT NUMB R 6/ ~D- 0 S - () J () R' ~ Y L
ADDRESS /57 3 d !Q V M ~ s: ()
~~ SET BACkS Date
~ Front
.;-/v\vJ \ ~/ Rear
~ oY'1 SIde Flanking
. SIde
FOOTI~G REBAR /' Date 1!)ZV
FOOTING
~ 12"
o 16"
o other
o required \ ents
WALL REBAR ~ate 1J.M---
WALL
CJ 6"
o 8"
o other
Comments
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CO\lBI:\ED FRA~lE/ EXTERIOR SHEAR WALL I\SPECTIO~
Hold downs :J Shea,r NaIling ;?-. .J
Frame "'J/ (1...v ~v. Gas Propane ;--:,~
Plumbing -S lAt:>t. . flU! &fly MechanIcal J ;-~
v~ / '"
Commentsjl~bl~ SK^rS) ~\JA~ ~ w~ ,tJ(\( f 'fj/
I\St L.\ TlO~ J Gas ~ ElectrIC
o Foam and Seal ~ Vapor barner
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cri4-~
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n Other
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Comments
SHEET ROCK/SHEAR \V .\lL ;\AIL
Comments
OTHER
Comments
F1"iAL
o Sewer Final
o Address
Q Electrical
[J InsulatIOn
o C1\ 11 Final
o SIte DraInage
[] Landscape FInal IJ C of 0
:J Slde\\ alk.
Comments
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YE:LM SEWER DEPT
FRX NO 360-458-8166
Nov 07 2005 10 16RM Pi
FAX TRANSMISSION
CITY OF YEfLM
P.O BOX 479 -"- 931 NP ROAD NE
YELM,W A 98597
360-458-8411
FAX 360-458-8166
TO:
DATE. 11-7-o~
PAGES' J, including this
Cover sheet
FAX#:
From: KAl\Jo'r
SubJect. HolASco r\;;AV'i'c:LitY\ laL\UI
COMMENTS' L6 T :; 7) 15'7 3~, /6t..(fId Au~ 5 E
OL5 -5 370 00
** If you do not receIve all copies or any copy IS Ilolleglblc, please call (')60) 458~R411
as soon as posslhk
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-05-0168-YL
Issue Date 06/15/2005
(Work must be started within 180 days)
Receipt No
37017
J\pP!icar:a!:
Name: Evergreen State Builders
Phone:
253-475-6622
Address. POBox 39753
City. Lakewood
State W A Zip 98499
Property InformCition:
Site Address, 15732 104th Ave SE
Assessor Parcel No, 85840003700
Subdivision. Yelm Terra
Lot: 37
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
Proje.c:t Informati(m~
Project: Yelm Terra
Description of Work: Plan 1818 S/2 Lot 37
Sq, Ft. per floor' (1st) 547 (2nd) 1271 (3rd) 585 Garage 0 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 1,175,58 993,75 181 83 5 6000 32,4700 $1,000
Building Plan Review 496,68 000 000 o 0000 0,0000
Mechanical Permit 78.75 000 000 0,0000 o 0000
Plumbing Permit 132,00 20,00 112,00 7 0000 16.0000 Fixture
Sewer Inspection 14500 000 145.00 145 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 0,00 o 0000 o 0000
Water Deposit 4000 40,00 000 o 0000 o 0000
Traffic Facilities Charge 757,50 000 757,50 750 0000 1 0100 Peak PM Trip
Sewer Deposit 5000 5000 0,00 o 0000 o 0000
State Building Fee 4,50 450 0,00 0,0000 o 0000
SewerERU 5,41700 000 5,41700 5,4170000 1 0000 ERU
TOTAL FEES $10,097.01
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,
easeme s and restrictions of record, If applying as a contractor, I futher certify that I am currently
registered the State of Washington
# Sets of Prints,
Final Inspection:
Signature
Date
Date.
By'
Firm
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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. POBox 39753
Project Information:
Project: Yelm Terra
Description of Work: Plan 1818 5/2 Lot 37
Site Address, 15732 104th Ave SE
Fees.
Item Acct Code
-------------- --_..-----
Building Permit 100-500k 032001-322-10-00
Building Plan Review 100 001-345-83-00
Mechanical Permit 032 001-322-10-00
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 420 120-344-85-00
Sewer Deposit 742402-389-01-00
State Building Fee 160001-386-00-00
Sewer ERU 802 412-343-50-01
Permit Fees Schedule
Permit No BLD-05-0168-YL
Phone:
253-475-6622
City' Lakewood
State: WA Zip 98499
Assessor Parcel No. 85840003700
Item Fee Base Amt Unit Fee Unit Rate No, Units Unit Desc
-----------
1 175,58 993,75 181 83 5.6000 32,4700 $1,000
496,68 0,00 000 o 0000 o 0000
78.75 000 0.00 0,0000 o 0000
132.00 2000 112,00 7,0000 16,0000 Fixture
145.00 0,00 145 00 145,0000 1 0000 ERU
1 500,00 000 1 500 00 1,500,0000 1 0000 ERU
300,00 300 DO 000 o 0000 o 0000
4000 40,00 0,00 0,0000 o 0000
757 50 0,00 757 50 7500000 1 0100 Peak PM Trip
5000 50.00 0,00 o 0000 o 0000
4,50 4,50 0,00 0,0000 0,0000
5 417 00 0.00 5,41700 5,4170000 1 0000 ERU
RECEIPT No.3 7 0 1 7
I REPF1'{EfEN THOUSA.ND NINETY SEVEN DOLLARS & 01 CENTS
HICHELLE
PERMIT1175 58,BLDPLREV496 68,MECH78 75,PLUM132 .SEWIN~P14~ ,W!~RU1500 ,
WTfiET300 ,WTDEP40 .TRAFCHG757 50,SEWDEP50 .STBLDFEE4 ~0,SbWERUj417 00
....T,....~~7
RECEIVED FROM
EVEFGFEEN STATE BUILDERS
POBOX 39753
LAKE WOOD WA 98499
SITE 15732 104TH AVE SE
BLD-05-0168-YL
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DATE
06/15/0:,
REC. NO
.37017
AMOUNT
10,097 01 CHECK
REF NO.
PENDING
Oq?(}I
BUDGETARY
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Yelm School Distrlct
ATTN SUSAN CROY
PO BOX 476
YELM, ~jA 98597
360-458-1900
Sold to 16755
EVERGREEN STATE BUILDERS LLC
56622
BUILDERS LLC EVERGREEN STATE
5516 75TH ST W #1
LAKEWOOD, WA 58499
# 6073 09 06/15/05
Reg #1 SalesPerson SUSAN
Item # 2900/MITIGATION
MITIGATION/CAPITAL PROJtCTS
1 @ 6,844 00 6,8~~O
4 CK #09865 FOR YELM TERRA LOT~ ,39,93,9
SubTotal
6,844.00
Total Due
Check
6,844 00
6,844 00
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Thank you
PLEASE KEEP THIS RECEIPT' I I
SITE PLAN APPROVA~
APP~CVf,ll ^S rRmNI~b IEVISE ^ND,~~
REVltW~D BY (CLlENI~
05/10/2005 12 43
DATE'
NOT~~,
2532843183
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CAS RES NWAF TD~
LOT 31
EVERGREEN STATE BUILDERS
YELM TERRA
16732 l04thAVENUE SOUTHEAST
YELM, WA
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STORM
SEWER
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LINE ------r--'.-----'---- - ----, r---~
UNE-----~------ -----______L___
: 104th LOOP SE
LINE ~-==-b.:-=.~---'~='=____=eJ~
WATER
. SITE PLAN
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@ 2004 CASCADE RESIDENTIAL DESIGN, INC
PAGE 02/05
@
NORTH
SCALE I~ : 30'
THIS DRAWING IS 9ASEO ON CLlE'IT-~~OVlbED INFORMATION REFRESHITI1D TO 8E ACCU~AtE .
AND ~ELIABW:_ ANY DISeRf-PANCIES BHWEEN THIS DRAWING AND THE ACTUAl. SITE CONDITION,
ARF, TI~E SOl.. RESPONSIBILITY or THE eLlEN,_
Project _/'8'0/,.0 J!:;_~)Y/~___ ~ r:t~ It _---.J'Jt,f' ~ ~__
SUbdiViSlon;~~h1 I-€((tt lol#'_1_Z~~ loning; ,*l!t~ -l{f!t1t..t../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 Olhar
Project Description/Scope of Work:~{e .n~h~~e.:Sf riM/lel.1
Project Value ;;;;. 9/ 9..s-o
Building Area (sq ft) 18f FIOO~~ 7 till Floor/"'? 7L Garage s;$'.s- Deck /6 CJ
Basement Carport Patio
# Badroom03- # aalhroomoZS - H..tjn~~~r ELEC~RIC (Circle One)
Are there any environmentally sansitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application
9UILOrNGOWNERNAME,~-'- ~-/, ~ I _...~ .5bJli~~:r~? , ~ --']
AODRlJlk~~S~:/()D' 1t\ /, ..~.' ..EMAll L-...-.c! ""~. I.udt~hiuz-:f..
CiTY . STATE._ lIP._:t '~TElEPH~lL~ ~ _
ARCHITECTIf;NGINf;ER-~~~irAjCENSE #__ ,: . ]
ADDRESS h2. ~..?:~!!F"ii7! _EMA!l~i~2 2;2' ~ . ,z:-
CllY-7Z(el!rtJEL-_~ STATE~..?2T"'~ffiz ,TELEPHONE.. -.. (('l_-(j/10
GENERAl. CONTRACTOR. \~/IIlIJ,# ci.$ {!}WLU' TELEPHONE__ I ---
ADDRESS ," .. -~-' EMAiL ---- I.
CITY STATE ZIP FAX
CONTRACTOR'S LJCE~SE # ~;;ot ~PDA IEiiioiYUCENSE #_
-PiIiMaING CoNT~lOR-~Mi i7i~1El.EPHONE~53. .7-if9lJ ()
ADDRESS.Jl?'18 ~o/I'r zw-7~ EMAil
CITY 7C1({iiYiflC-:"=-'sTATE . ZJPljr"FW?-FAX;2 ~~ ...5":~~~ __
CONT~CTOR'S LJC~N~~!';.::::".___._~..:c-~ F.J<P DATE_CITY LICENSE #
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...TELEPHONE. __
. _____EMAll ._.____..
ZIP FAX
", ~_ EXP DATE,...,__..C1!y UC~S~#_.._,__
MECHANICAL CONTRACTOR__..__
ADDRESS
CITY 5T ATE
CONTRACTOR'S liCENSE #
Ct>pyof mitioation agreement with Yelm Community Schools. if applicablQ
I hemby certHy UtilI d'ltlllboYII Information il!l ,"Orr'l/(;<< alld that the conSb'ucl/on 0". ~md fhe t)IC:CUpl3ll1cy and thll use 0' the
above described property will btll" accordunCll wllh the IOWII, mllllJ slid r~{jlllotlons 01' the Stille of WllfJhlnyton and the
Clly of Velm.
L~-.~ ._~. ____. 6-/7-6.5-
Applicant" SignaturJ_._.,------- Date
Owner I Contractor(OWner's Ag~ COl1tractor's Agent (Please circl, one.)
-----......--
All permits are nonwlransferabJe and will expire If work auth()W'i~&d by such permit Is not begun
within 180 days m issuance, or If work is suspended or abandoned fOf a period of 180 days
10.(; felm Averaufl West
PO Bo~ 479
Yelm.. WA 98597
(360) IJI1lJ.38,JJ5
(369) 4lJIJ..3144 FAX
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