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.
O Washington State Dept of Labor & Industries Use of this site is subject to the laws of the state of Washington.
https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602485727&LIC—�'iRAFF**895LH&SAW= 2/3
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