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Home My WebLink AboutCOM2010-00006 DEMO, Bank, Final - COM Permit / Conditions - 4/12/2010 n Q N ch co $ � 0 �' o � p -+ r — m m � o rn n 0 m � y n _ o m o21 � mp o � n � gz � �r ' c 9 * 0 08 CA � o rD- c M r0ii 0 D Z Wo o U) r CA D $; � � � � aoO Zm 3 p pNmcy �'o � C er •-a .. m All)0 p M m C p m r m 0 Q m g m < a Z - 0C � 0m c nD a � � xS A . ° C ; CO) 0 Cl) r 2 z � 9 CA) C_ 4 OD pW r e g mAS.M rkP awZ O N Q m �, w r o ° w mMe m 0 o ami H y D m x CO) 70 'O g 0 O ;—' C —I m •a.•) O sCi o i► o 5 p w +� 8 N o y o m p�j N O d5 m o to r z CA 0 o: �, m z O N mmr�r � 13 cn cnQQ c A � � N a 0 C v J J 0 N N i O • ,O J cD S a "" xQ,' � x S6v x m0 � m 41 Hag n - m;a 8.8 � x a � � fy , N N air if m a$ 78 ° � - 'M3 ' o - � , � � yo � n g c H - $ �v 8 79 Q 9D ;D G) cow CO lit Z rfi- fil US U 00 C7 , m i c� CD $ 8 SRa Z S m a C a N CL � v � Z �l ! z $ H=L. 0% m ohm a 5°' • a �� g c 3 � C -� m0 o � 8 151 mm$ .0 :� $ � 8 fit a 5. 0 m000)00 d ; Om O N (D 5;0 g O n a » n -w g w gg19 IDo � cc_ D $ 3 O t1P 1 a o O N CONCRETE MECHANICAL MANUFACTURED HOME o Date By ic o Footings I Setbacks Gas Piping Ribbons o Interior Date By Interior-Date By Date By rnExterior Date By Exterior-Date_ B fit. m Point Load I Isolated Footings INSULATION Date By 0 BG I SLAB INSULATION --- M Date By Date By FIRE DEPARTMENT _ D Foundation Wails Floors Date By l" Date By Data gy DECKS y FRAMING Walls Date By < Date By Data By PROPANE TANKS G) PLUMBING vault Date By Cl) Date By OTHER Groundwork Attic Date By Date By Type: Date By D.w.V DRYWALL n Type_ O Int.Brace Wail Date By 0 Date ey Date By FINAL INSPECTION M Water Line Fire Seperation Dale By Date By Date 2 By O O Pass or Request Inspect c Type of Insp. Fail Date Date Done By Comments a, w 0 w FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD PERMIT NO.: Como 26I b—6"& ION COUNTY DEMOLITION PERMIT APPLICATION 420 W.Cedar/P.O.Box 186,Shelton,WA 88884 Shelton 27-eE70 Belfa 60 276 4t67 Ekm 06014=41M 4868 APPLICANT INFO RNIA CONTRACTOR INgO ATION, Owner Contractor NameAne Mailing Add Mailing Addressff As City VI f State Yip Code CityTuWNvAf4-e` 9tate0J Zip Code Phone her Ph.( Ph.(_) Other Ph.(� Lienlritle Holder Contractor Reg.# Address Expiration PARCEL INFORMATION-12 digit Tax Parcel No. / _/ Fire District Legal Description Site Address(include reet nam and ity D'r ctio s o ite: Is your pr4prty within 200'of the following: Body of Water(Name) nn Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs if your project is located adjacent to or within an area that is listed above, it is advisable to contact the Dept. of Community Development regarding future development prior to demolition;since removal of an existing structure could affect future building locations. H w will t ris be disposed of? 1't NJ What is the use of the building being demolished? NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR A13ANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the infomration provided is accurate and grants employees of Mason County access to the above described property and structures for review and Inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVITtI certify that I am currently registered as a the Contractor Registration Law RCW 18.27 and am aware of the contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work ordinance requirements regulating the work for which this permit is issued will be done in conformance therewith. No changes shall be made without and all work shall be done in conformance therewith. No changes shall first obtaining approval. be made without first obtaining approval. X Date X Date Provide a plot plan indicating location of improvements and structure to be demolished. FOR OFFICIAL USE BEYOND THIS POINT Untitled Page Page 1 of 3 Gbneral/Specialty Contractor A business registered as a construction contractor with L&I'to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Business and Licensing Information Name ANDY JOHNSON/CO UBI No. 342010765 INC Phone 3603523110 Status ACTIVE Address PO BOX 46 License No. ANDYJ"*240QT Suite/Apt. License Type CONSTRUCTION CONTRACTOR City OLYMPIA Effective Date 11/30/1976 State WA Expiration 1/1/2012 Date Zip 985070046 Suspend Date County THURSTON Specialty 1 GENERAL Business Type Corporation Specialty 2 UNUSED Parent Company Business Owner Information Name Role Effective Date Expiration Date JOHNSON, DONALD A 01/01/1980 JOHNSON, S RANDALL 01/01/1980 Bond Information Bond Bond Effective Expiration Cancel Impaired Bond Received Bond Company Account Date Date Date Date Amount Date Name Number SAFECO Until 4 INS CO OF 5332013 12/18/2001 $12,000.0012/20/2001 AMERICA Cancelled SAFECO 3 INS CO OF 5332013 01/01/199812/18/2001 $6,000.00 AMERICA r2SAFECO 5332013 101/01/1987 01/01/1998 1 1$6,000.00 https;Hfortress,wa mov/lni/bbip/Detail.aspx 1/22/2010 ' Untitled Page Page 2 of 3 INS CO 1 AMERICAN 6313877 1/01/1982 01/01/1987 INS CO Insurance Information Insurance Company Policy Number Effective Expiration Cancel impaired Amount Name Date Date Date Date ZURICH 26 AMERICAN GLO28624907 01/01/2007 01/01/2011 $1,000,000.0( INS CO ZURICH 25 AMERICAN GLO28624904 01/01/2007 01/01/2008 $1,000,000.0( INS CO ZURICH 24 AMERICAN GLO28624920 3 01/01/2005 01/01/2007 $1,000,000.0( INS CO ZURICH 23 AMERICAN GL02862492 01/01/2004 01/01/2005 $1,000,000.0( INS CO ZURICH 22 AMERICAN GL0286249200 01/01/2003 02/01/2004 $1,000,000.0( INS CO ZURICH 21 AMERICAN CPO286249200 01/01/2003 01/01/2004 $1,000,000.0( INS CO AMERICAN 20 ECONOMY 02CC1818663 01/01/2002 01/01/2003 INS CO AMERICAN 19 ECONOMY 02CC1818662 01/01/2001 01/01/2002 INS CO AMERICAN 18 ECONOMY 02CC1818661 01/01/2000 01/01/2001 INS CO AMERICAN 17 ECONOMY 02CC1818660 01/01/1999 01/01/2000 INS CO AMERICAN 16 ECONOMY 02CC18186609 01/01/1998 01/01/1999 INS CO AMERICAN 15 ECONOMY 02CC18186608 . 01/01/1997 01/01/1998 INS CO 14 AMERICAN 102CC1 8186607 01/01/1996 01/01/1997 ECONOMY https.Hfortress.wa.gov/lni/bbip/Detaii.aspx 1/22/2010 Untitled Page Page 3 of 3 INS CO AMERICAN 13 ECONOMY 02CC18186606 01/01/1995 01/01/1996 INS CO AMERICAN 12 ECONOMY 02CC181866 01/01/1994 01/01/1995 INS CO AMERICAN 11 ECONOMY 02CC18186604 01/01/1993 01/01/1994 INS CO AMERICAN 10 ECONOMY 02CC18186603 01/01/1992 01/01/1993 INS CO AMERICAN 9 ECONOMY 02CC18186602 01/01/199101/01/1992 INS CO AMERICAN 8 ECONOMY 02CC18186601 01/01/1990 01/01/1991 INS AETNA 7 CASUALTY C0163057 01/01/1989 01/01/1990 Et SURETY CO AETNA 6 CASUALTY C0128276 01/01/1988 01/01/1990 Et SURETY CO AETNA 5 CASUALTY at SURETY 81 CO0754474CCA 01/01/1987 01/01/1988 CO AETNA 4 CASUALTY Et SURETY 81 C075474CCA 01/01/1986 01/01/1987 CO 3 ROYAL PYAG62108 01/01/1984 01/01/1986 INS CO 2 ROYAL PYA295555 01/01/1983 01/01/1984 INS CO 1 ROYAL INS CO IPYA267529 101/01/1982 01/01/1983 https;Hfortress.wa,gov/lni/bbip/Detail.aspx 1/22/2010