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20140297 Permit Pkg 02102015 ��Q'� �HEA� City of Yelm Permit ►vo.: 20140297 � �� Community Development Department Issue Date: 2/10/2015 (Work must be completed within 180 days) Building Division Phone: (360)458-8407 L "'.""'"`��" Fax: (360)458-3144 Applicant: Name: ROSEMONT RETIREMENT Phone: 503-588-3505 Address: 215 KILLION RD YELM WA 98597 Property Information: site Address: 215 KILLION RD NW owner: Assessor Parcel No.: 21724120404 Subdivision: N/A Lot: Contractor Information: Name: GRAFFIX Phone: Address: CHRIS RICHARDSON 145 S. HORTON ST#1 SEATTLE WA 98134 Contractor License No.: 11085 Expires: 12/31/2015 Project Information: Project: SIGN Description of Work: REPLACE 2 EXISTING Sq. Ft. per floor: First Heat Type (Electric, Gas, Other): Second Third Garage Basement Fees: Item Contractor Fees SIGN GRAFFIX $ 40.00 TOTAL FEES: $ 40.00 ApplicanYs Affidavit: 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 #Sets of Prints: 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 further certify that I am currently Final Inspection: registered in the State of Washington. Signature Date 2 (� �S Date: Firm By� Cit� of 5�1m44 (36 ) REC�: 0018619ERM: 0(ll�/2015 E:31 AM OPER. REF#: 16015 PAID BY: TRAN: 33,0000 ��I�-pI40.00CRjTS 20140297 ROSEMONT RETIREMENT 215 KILLION RD 40,OOCR SIGN TENQERED: 40.00 CHECK APPLIEQ: 40.OQ- CHANGE: 0.00 CITY OF YELM ���W� ����'`7 � SIGN PERMIT APPLICATION FORM Project Address: 215 Killion Rd NW Parcel#: Zoning; C1 Current Use: Assisted Living Proposed Use: Same Type/Number of Sign(s) (wall, monument, lighted, etc.): 1 Monument and 1 directional si�n Value of each Sign: $7,400 , $807 Dimensions of Sign(s): Monument 8'x 3'-6" (tot�l he�ight 5'-10"), directional 4'x 1'-6" Building Gross Floor Area (sq. ft): 32,000 Building Height: 4oft Existing Signage (if any)and dimensions: Replaces existing 8'x 3' sign and 2'x 8" sign ,. . . : F� Pegg}' Last Name First Name ADDRESS 145 S Horton St#1 EMAIL pe��vC��raffixinc.com CITY Seattle STATE�g_ZIP 98134 TELEPHONE 206-324-8117 resti e are nc ADDRESS 7700 NE Par way Dr EMAIL mca i as resti ecare.com CITY Vanc�uver STATE�_ZIP 98662-665�ELEPHONE 60- 56-33 2 BUILDING TE . Presti�e Senior Livin�Rosemont ADDRESS �1 S Killinn T2r�NW EMAIL CITY Yelm STATE�_ZIP 98597 TELEPHON 2�h-324-R117 ra ix TELEPHONE 206-324-8117 ADDRESS 145 S Horton St#1 EMAIL T Puuvna vraffixin_c�m CITY Seattle STATE�pg_ZIP 98134 FAX CONTRACTOR'S LICENSE# GRAFF**895LH EXP DATE06/15CITY LICENSE# I hereby certify that the above information is correct and that the construction of the above described sign will be in accordance with the laws,rules and regulations of the State of Washington and the City of Yelm. ---�G� 11/26/14 Applica s Signature Date Owner I Contractor I Owner's Agent I(Contractor's Agenty Tenant (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 » _ __ ___ _�__. �,-�-.�-�.,� . �� �� i �, a�1 .l� DEC082014 ]05 Yelm Aue W (360)458-3835 Yelm, WA 98597 (360)458-3144 FAX www.ci.yelm.wa.us 11/26/2014 GRAFF7X Washi�gton State Department of Labor & Industries GRAFFIX Owner or tradesperson 145 S HORTON ST# 1 RICHARDSON, CHRISTOPHER MARK SEATTLE, WA 98134 206-324-8117 Principals KING County RICHARDSON, CHRISTOPHER MARK, PARTNER/MEMBER Doing business as GRAFFIX WA UBI No. Business type 602 485 727 Limited Liability Company Parent company RICHARDSON HOLDINGS LLC License Verify the contractor's active registration /license/certification (depending on trade) and any past violations. Construction Contractor Active. ........................................................................... Meets current requirements. License specialties Signs License no. GRAFF"*895LH Effective—expiration 06/08/2011—06/08/2015 Bond . .............. No bond accounts during the previous 6 year period. Insurance ............................_ Mutual of Enumclaw Ins Co $1,000,000.00 Policy no. CPP 0005852 01 Received by L&I Effective date 04/07/2014 06/01/2012 Expiration date 06/01/2015 Insurance historv Savin�s ........... ..... (in lieu of bond) $6,000.00 https://secure.lni.wa.gov/verify/Detail.aspx?UBI�02485727&LIC=GRAFF**895LH&SAW= 1/3 11/26/2014 GRAFFIX Received by L&I Effective date 06/08/2011 05/18/2011 Savings account ID 6280862043 Lawsuits ayainst the bond or savin�s No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts ......................................... No L8�1 tax debts are recorded for this contractor license during the previous 6 year period, but some debts may be recorded by other agencies. License Violations ........................................................ Infraction no. NBERU00567 Satisfied ....................... Violation date RCW/WAC 12/19/2011 18.27.200(1)(a) RCW Violation city Violation amount Seattle $500.00 Type of violation CONSTRUCTION INFRACTION Description Advertising, offering to do work, submitting a bid or performing work when not registered as a contractor, as required. In that Graffix submitted a bid and performed work as a contractor without being registered at the time. Workers' comp Do you know if the business has employees? If so, verify the business is up-to-date on workers' comp premiums. L&I Account ID Account is current. 095,356-00 ............................... Doing business as GRAFFIX Estimated workers reported Quarter 3 of Year 2014"11 to 20 Workers" L&I account representative T5/MICHAEL MURPHY(360)902-4822 - Email: MURY235@Ini.wa.gov Workplace safety and health No inspections during the previous 6 year period. 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