20040159
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CITY OF YELM - BUILDING DEPARTMENT
RESIDENTIAL CERTIFICATE OF OCCUPANCY
Building AddresS
1?862 ~ 041\1 Av~E
Building Permit Number -
gyerQreen State Builde~
p.O. Box 39753
Lakewood WA 98499
owner Name
owner Address
Plan Number
Plan ~ 740B/2 Lot 55
BLD-04-0~ 59- YL
RemarKs
special Conditions
.61\ Code reQuired -
Areas Inspected -
Date
March 2 ~ , 2006
Building Officia\._
G Carlson
This structure is in comphance with the Internationai Residential Code (Chapter
51-51 WAC) as adopted by the Washington State Building Code council pursuant
to Chapters 19 27 and 70 92 RCW, effecti.e July 1, 2004
\f&\1@1~~@lJ@f@f@f@ll@f@\@I@.\@l\@\If;;l\mill
Jon Yana5ak
360-458-7937
p. 1
FAX TRANSMISSION
CITY OF YELM
r.o nOX479-931 NPROADNE
YELM, W A 98597
360-458-8411
FAX 360-458-8166
TO. ~ '( G.~C:,..J
\
DATE. 3 .2-a~
FAX#: l( 5-9 -l-f ~ L{ 8
PAGES: I , includmg this
Cover sheet
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From'
Subject:
COMMENTS-
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U IfyolI do not receIVe a.ll caples or any copy IS not legible, please call (360) 458-&411
as soon as possible.
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City ofVelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Permit No
BLD-04-0159-VL
Issue Date 10/12/2004
(Work must be started within 180 days)
Receipt No
33409
~ppT!~~rit:
Name: Evergreen State Builders
Phone.
253-475-6622
Address. P.O Box 197
City' Lakewood
State W A Zip 98499
ProPElrty Inform~!Lon
Site Address. 15862 104th Ave SE
Assessor Parcel No
Subdivision. Yelm Terra
Lot: 55
Contracto(l!lform atian.
Name: Evergreen State Builders
Contact: McCullem, Tom
Phone 253-475-6622
Address POBox 197
City. Lakewood
State. WA Zip
Contractor License No. EVERGSB980PB
Expires. 10/02/06275
Business License.
Project ji,Tormation
Project: Yelm Terra
Description of Work: Plan 17 40B/2, Lot 55
Sq. Ft. per floor' (1st) 854 (2nd) 952 (3rd) 0 Garage 418 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 1,14915 993 75 155 40 5 6000 277500 $1,000
Building Plan Review 74694 000 000 o 0000 o 0000
Mechanical Permit 78.75 000 000 o 0000 0.0000
Plumbing Permit 111 00 20.00 9100 7 0000 13 0000 Fixture
Sewer ERU 5,26900 000 5,269 00 5,269 0000 1 0000 ERU
Sewer Inspection 145.00 0.00 145 00 145 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 0.0000 0.0000
Water Deposit 4000 4000 0.00 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 o 0000
State Building Fee 4.50 4.50 000 o 0000 0.0000
TOTAL FEES $10,151.84
Applicant's ~ftadavft: .
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor, I futher certify that I am currently
registered in the State Was Ington.
OFFICIAL USE.ONL Y
# Sets of Prints.
Final.lnspection.
Signature
Date:
3~"-OGJ
#f}
By.
Firm
. .
u
RECEIPT No. 3 3 4 0 9
RE$tiIV..f.D
* TEN THOUSAND ONE HUNDRED FIFTY ONE DOLLARS & 84 CENTS
RECEIVED FROM
EVERGREEN STATE BUILDERS
PO BOX 197
LAKEWOOD WA 98499
SITEz 15862 104TH AVE SE
DATE REC. NO.
10/08/04 33409
AMOUNT
10.151.84 CHECK
REF NO
PENDING
MISCELLANEOUS RECEIPT
JANnrE
BLDPRMTl149.15. BLDPLNREV746.94. MECHPRMT78.75. PLMBPRMT111.. S/ERU5269.
S/INSP145. W/ERU1500. W/MTR300. W/DEP40. TRAFF757.50. W/DEP50. STATE4.50
/fif-
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Applig~nt:
City ofYelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
o
Address. POBox 197
Name: Evergreen State Builders
ProjectlriformaJi~on' .
Project: Yelm Terra
Description of Work: Plan 1740B/2, Lot 55
Site Address. 15862 104th Ave SE
Fees
Item Accl 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 ERU 802412-343-50-01
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
TOTAL FEES
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Permit Fees Schedule
Permit No BLD-04-0159-YL
3~YO(
Phone.
253-475-6622
City. Lakewood
State. WA Zip 98499
Assessor Parcel No
Item Fee Base Amt Unit Fee Unit Rate No Units Unit Desc
-------------
1,14915 993.75 155 40 5 6000 277500 $1,000
74694 000 000 o 0000 o 0000
78.75 000 0.00 o 0000 o 0000
111 00 2000 9100 7 0000 13.0000 Fixture
5,269 00 000 5,26900 5,2690000 1 0000 ERU
145 00 000 145 00 145.0000 1 0000 ERU
1,50000 000 1,50000 1,5000000 1 0000 ERU
300 00 300 00 000 o 0000 o 0000
4000 4000 000 o 0000 o 0000
757 50 000 757 50 7500000 1 0100 Peak PM Trip
5000 5000 000 o 0000 0.0000
450 450 000 0.0000 o 0000
$10,151.84
09/28/2004 10 41
253?P43183
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CASCADE RESt::)TIAL
PAGE 02
LOT 55
EVERGREEN STATE BUILDERS
YELM TERRA
YELM, WA
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{> 2004 CASCADE REsIOENTI/\I.. DESIGN, II\IC
T~IS DRAWING IS eA,ED ON eLlF;NT -PROVIOtD IN"O~HArION RF.PRr:~"NnD TO BF. ACCIJ~ATE
AND R~~IABLE. ANY DISC~[PANCIES 9[TWE~N TI'IIS DRAWINC ,,~() THe ACTUAl, ~ITE CONDITIONS
AR~ THe SOLE Rr.SPONSI81,ITY 0, TH~ CLIENT
9/28/200410.:24121 AM. 1.%0
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f"\ CITY OF YELM ~
I\..JJDENTlAL BUILDING PERMIT APPLICJ0N FORM
Project Address. Parcel #.
SUbdivision:~'elW'\-t'e:(<~ Lot#. 55 Zoning;
l/New Construction u Re-Modell Re-Roof I Addition U Home Occupation Sign ~ ~ C'
U Plumbing U Mechanical u Mobile I Manufactured Home Placement u Othe~ ~I !/ I:.
Project DescriptionlScope ~ WOrk:~ ~ \ ~ f ~"'^- \\ -I (I' <9 lDu1 {)
Project Value: ,\ '2.S \ Oae) ,
Building Area (sq. ft) 1st Floor 85i. 2nd Floor9Sz.. Garage 'i~B Deck N/JL
Basement jJ J ft Carport ,J)1t Patio \ a .'1- \ 'Z..^=" \ W .~
# Bedrooms :s # Bathrooms 2,/-1. Heating:~OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? ).)0 If yes, a
completed environmental checklist must accompany permit application.
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EMAIL
TELEPHONE:z.~3- 475 -6 trZZ
ARCHITECTIENGINEER Cl\-s.LM)\:. LICENSE #
ADDRESS J 0 2.. ~O~ U'tla '!O,,;T EMAIL
CITY (,it"U:Jl"'\,4 STATE vJ1t ZIP t:t-e~o2.. TELEPHONE "2.b3=-2 8'~- ~li0
GENERAL CONTRACTOR ~~ . ,;-t-Ql) ~+I \C)f} TELEPHONE #53- '-17.5- G;!.2
ADDRESS -p.O' \)t.tyf. ~~'i15)> EMAIL
CITY ~~CO STATEWA ZIP~'l9 FAX - :!~-475-
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE
PLUMBING CONTRACTOR ~~ ~ ~.~~ (4\"i \(' TELEPHONE'J.-S3.-.5
ADDRESS teJ~ <=iCf'-iVf ~~ ~ EMAIL
CITY ~n1A-- STATEv.J If- ZIP ff3Cf-/..'j FAX:;z53-S3' - Cf6C 6
CONTRACTOR'S LICENSE #f>"J,qet* 2.\ 11. Go... EXP DA TE,1/a)"CITY LICENSE #
MECHANICAL CONTRACTOR He(,~ \1-~ffi.Jl':) TELEPHONE 2-:;- ct'22 - Z~\
ADDRESS 'fro' ~\~~(.. IN,,,,- EMAIL
CITY 7A:<-c.wn4- STATE W ~ ZIP Cf8Cj;q '1 FAX s~ - 7-
CONTRACTOR'S LICENSE #ttq-l-t:' -I~~D EXP DATEI . ITY L1CENS #
Copy of mitigation agreement with Yelm Community Schools, if appli
cV/,~d
~o/ay
I hereby certify that the above Information Is correct and that the construction on, and the occupancy and the use of the
above described property III be In accordance with the laws, rules and regulations of the State of Washington and the
C!tY of Yelm.
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plica's Ignature Date
Owner J ontractor J Owner's Agent Contractor's Agent (Please circle one.)
I - <\1 ~<:5d eeJ\ ,,-f. P-Jdrs
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
PO Box 479
Yelm, WA 98597
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wa.us
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Evergreen State Builders LLC (License # EVERGSB980PB)
5700 - 100th Street S W., Suite 630, Box 197, Lakewood, WA 98499
253-475-6622 (Fax 253-475-6127)
DESCRIPTION OF MATERIALS for
J
YELMTERRA
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8' ceilings on first floor
Siding:
8" pre-pnmed James HardIe lap SIdIng on front, James HardIe SIngle wall
SIdIng sIdes and back; James HardIe shakes or shake panels as accents
front elevatIOn per plan.
Roofing:
ArchItectural CompOSItion roof
Windows:
Vinyl WIndows to code and as per plan.
Driveway:
Broom fimsh.
PatiolW alkways:
Broom fimsh.
Cabinets:
Oak cabInets, flush panel.
Doors:
Embossed package.
Exterior:
Insulated steel, or fiberglass
Millwork:
Embossed package
Window Wrap:
Stool and Apron only
Plumbing:
Kitchen Sink: 33x22, 3-hole, double-SInk. StaInless WIth chrome delta faucet
Lavatory:
G Powder Room. whIte WIth Delta chrome faucet.
. Hall Bath. KIlgore whIte SInk WIth Delta chrome faucet.
. Master Bath. (2) 20x17 whIte WIth Delta chrome faucets
o Tub Valve. Master bath. Delta chrome or eqUIvalent.
. Tub/Shower Valve. Mam bath. Delta tub and shower valve
. Shower Valve. Master: Delta or eqUIvalent.
. Toilets. whIte, per plan.
t::..
Bath enclosures:
Hot Water Tank:
Hosebib:
Hardware:
Bath hardware:
Flooring:
Countertops:
Painting:
Appliances:
Wiring:
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Page one of two
Master bath: Clear glass door on separate shower With chrome tnm.
Tubs: Fiberglass white.
Gas 50 gallon.
Two per plan.
Locks mtenor: Chrome
Locks extenor: Chrome
Towel bars. Chrome
Paper holders. Chrome
Carpet: Dmmg room, hvmg room, stairs, bedrooms, closets, 6 lb, 1/2"
rebond pad.
Vinyl. Utthty room, hall bath and Entry
Lammate. Whole house
Extenor Tnm. White or color from approved hst.
Extenor Body: Flat sohd body pamt from approved Itst.
Front Door: Enamel, white or accent color from approved Itst
Intenor Walls. Drywall sealer coat, then one coat flat latex.
Kitchen and bathrooms. Low sheen enamel.
Range/Oven. Whirlpool white
Dishwasher: Whirlpool Self Clean, WhIte.
DIsposal. 1/2 HP
Icemaker: RefrIgerator space plumbed for Icemaker
Microwave. Wlnrlpool white
Phone (2) cable (2)
Page two of two