HomeMy WebLinkAboutBLD2013-00310 lk UILDING PERMIT APPLICA N BLD13-00310
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD13-00310 Received Date: 10/3/2013
SITE ADDRESS: 79 CLEAR VIEW PL#
PORT LUDLOW, 98365
OWNER: TIMOTHY A PERRY PHONE:
SHERRY G PERRY
79 CLEAR VIEW PL
PORT LUDLOW WA 983658001 TEAL LAKE VILLAGE
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 998700083 Section: 21 Township: 28 N Range: 01 E
CONTRACTOR: FAST WATER HEATER COMPANY PHONE: 425-636-7054
12601 132ND AVE NE
KIRKLAND WA 98034
Contractor's License FASTWWH948BC Expires 1/4/2014
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI SWAP OUT ELECTRIC WATER HEATER
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION ADD'L: HEAT TYPE: EEE
CODE EDITION: 2012 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $76.00 MEB 10/03/13 145421
Total: $76.00 APPROVED
OCT 0 3 2013
Jefferson County DCD
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r N JEFFERSON COUNTY
AilliA DEPARTMENT OF COMMUNITY DEVELOPMENT
,-,
621 Sheridan Street'Port Townsend•Washington 98368
4, . 360/379-4450. 360/379-4451 Fax
.yw ep www.co.jefferson.wa.us/commdevelopment
Master Permit Application MIA:
Project Description/(include separate sheets as pecessa-y.
mter. ,
_ t�� �,� j�'( � ` ; -
Tax Parcel Nu � Propenl,5izt..: (acres/square feet)
Site Address and/or Directions to Property: r 1 { 1. t`, iN t ' ( (( } I
Property Owner(s)of Record: '4 's 1. ) t _\\ ,i .� ; _ rt t-
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Telephone: ` it•-I - ( _a',/_) Fax r__ emgti.
Mailing Address: - ( I Cil 4'1. 'j
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► 1 -1(3(•.. tz `1 4
Applicant/Agent iif different from owner): kA'. 1.4 A' �,, C-f .- (ki(1.i_ili i. `f
4 'iglu
Telephone:t-(�-� �b. '1 t'� '7 Fax: 4.('�Sy'�,.�� ".1 tv�f'J�a email r Yf ii I'S(4L, �'�Y'
Mailing Address: ��` �
What kind of Permit?(Check each box that applies
❑Building ❑Critical Areas Stewardship Plan
O Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
i ASingle Family ❑Garage Attached/Detached 0 Conditional Use(C(a),C(d),or C]"
❑ Manufactured Home ❑ Modular ❑Discretionary"Cr or Unnamed Use Classification
O Commercial' 0 Special Use(Essential Public Facilities)"
❑ Change of Use 0 Boundary Line Adjustment
O Address ❑Road Approach 0 Short Plat"
O Home Business ❑Cottage industry ❑Binding Site Plan"
O Propane ❑Long Plat"
O Sign 0 Planned Rural Residential Development(PRRD)/Amendments"
O Allowed`Yes'Use Consistency Analysis 0 Plat Vacation/Alteration"
❑Stormwater Management O Shoreline Master Program Exemption/Permit Revisions"
O Site Plan Approval Advance Determination(SPAA))• ❑Shoreline Management Substantial Development••
O Temporary Use 0 Shoreline Management Variance
O Wireless Telecommunication• ❑Comprehensive Plan/UDC/Land Use District Map Amendment
O Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
•May require a Pre—Appfeatfon Confannce O Tree Vegetation Request
"Requires a P e'App/icaUen Confwence
Please Identify any other local,state or federal permits required for this proposal,if known:
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this a
NIIIP pplication 9 Pdicationforpermit(s).
IOWNER SIGNATURE 0 Date:
By signing this application fort,the owner/agent attests that the Information provided herein,and in any attachments,is true and correct to the best of
his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorneys fees and
1 expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
i
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
' review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application that he or trhe wants prior notice.
Signature: ..,11,1 .:- Date: L `_ G A)
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
'Endangered Species Act"or'ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or It holds individual
and non-transferable ressp nssi ty'for ad erng to and complying with the ESA. The Applicant has read this dis�rrryar�c)slim(a nil dates It below.
Signature: c A Date: 11C t/ t'11 �'�—∎
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J:\PernitCc'_ari###FrORMS###\DRD FORMS\Muter Pmnit Application 5-29•08.doc
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BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
FAsSr wietretz. Ruder l 04 08
636 `79 (4063 L. �)°S'�
MAILING ADDRESS: I A b I i"J Z / jQ- `a-IL EMAIL: I t0.19/1-tcafea-kaaker-Low)
CONTRACTOR'S LICENSE C O LjWAINS
NUMBER: Fitsrpowti"r'`7 3 12)(1. NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: ❑ Sewer
O Addition 0 Steel Proposed: Bank ❑ Community System
X Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
El Repair 0 Masonry SEP Permit#
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 Two Party
Type of Heat: Proposed: El Public
Total: Name of System:
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
I Underground Tank 1 Above ground Tank Size of Propane Tank:
1 Heat Stove I Cook Stove I Woodstove I Fireplace Insert 1 Hot Water Tank I Pellet Stove I Other
Is this appliance being installed in a Manufactured 1 Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
includin• the reserve area. _
t
S•uare Foote.e Current P ••osed ,T'-a+ �_., 1 ra " t. '-� ' ` a -: tQ_
x �aay�..,r�..��c ..tr:,�§�' Q� 'his '_an '�-tlfi'- �-���,.._�-.
Main Floor Heated ;°"6Ver4 EH Bid App Review:
s '.T�
2°Floor Heated � Consistency Review:
Other Heated ,,, "•• Base fee:
Mezzanine • Additional Section:
I
Heated Basement ,V.:, 4 , Plan Check fee:
Unheated Basement f State Surcharge fee:
;44,6 f .°-, :ii-
Other
Unheated " 4- = Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 3 �. 911/Rd Approach fee:
Other tookey !Uta„x-C-, 1 ,t .i, . ,,•„-ill TOTAL: $
R• eceipt Number:
t. Z,7r C• ash/Check Number:
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish
Initials: '
G:\PermitCenter\###FORMS###\ORD FORMS\Master Permit Application 5-29-08.doc
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OWNER AUTHORIZATION FORM 1
4 Yi m off+- ?r="Q am the o w n e r o f the 2 ' -°' - 4
(Owner mate) (Parcel or building)
located at-7q Ci ja,2 V F w ?IA cf. is J cfSG') Com--j 1Ortindas such
(Site Address) I
authorize 0AkC E k' to apply for all applicable permits for
(Name ofApplicant)
the purpose of f e. Ac)\)Q 4 c.ep a( e uc--
•
6),„w
Owner S' ty Date
Trnoi 4/ ?1 1 'I
Print Owners name here •
Contractors or Tradespeople Peer Friendly Page Page 1 of 1
General/Specialty Contractor
A business registered as a construction contractor with L8I 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 FAST WATER HEATER COMPANY UBI No. 601933036
Phone 4258143124 Status Expired
Address 12601 132Nd Ave Ne License No. FASTWHC052DF
Suite/Apt. License Type Construction Contractor
City Kirkland Effective Date 3/6/1995
State WA Expiration Date 2/16/2007
Zip 98034 Suspend Date 4/14/2006
County King Specialty 1 General
Business Type Corporation Specialty 2 Unused
Parent Company
Other Associated Licenses
Specialty Specialty Effective Expiration
License Name Type 1 2 Date Date Status
FASTWWH948BC FAST WATER Construction General Unused 1/3/2006 1/4/2014 Active
HEATER COMPANY Contractor
FASTWHC110MC FAST WATER Construction HEATER CO General Unused 7/3/1989 6/19/1995 Archived
Contractor
Business Owner Information
Name Role Effective Date Expiration Date
JOHNSON, DAVID 01/01/1980
JENINSON, RAYMOND President 01/01/1980
JORDON, JEFF Secretary 01/01/1980 01/03/2005
Bond Information No records found for the previous 6 year period
Assignment of Savings Information No records found for the previous 6 year period
Insurance Information No records found for the previous 6 year period
Summons/Complaint Information No unsatisfied complaints on file within prior 6 year period
Warrant Information No unsatisfied warrants on file within prior 6 year period
Infractions/Citations Information No records found for the previous 6 year period
https://fortress.wa.gov/lni/bbip/Print.aspx 10/3/2013
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MECHANICAL AND DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD13-00310 Received Date 10/3/2013
SITE ADDRESS: 79 CLEAR VIEW PL# Issue Date 10/3/2013
PORT LUDLOW, 98365
APPLICANT: TIMOTHY A PERRY PHONE:
SHERRY G PERRY
79 CLEAR VIEW PL
PORT LUDLOW WA 983658001
SUBDIVISION: TEAL LAKE VILLAGE Block: Lot:
PARCEL NUMBER: 998700083 Section: 21 Township: 28N Range: 01E
CONTRACTOR: FAST WATER HEATER COMPANY PHONE: 425-636-7054
12601 132ND AVE NE
KIRKLAND WA 98034
Contractor's License FASTWWH948BC Expires 1/4/2014
OWNER, TIMOTHYA PERRY PHONE:
if different: SHERRY G PERRY
79 CLEAR VIEW PL
PORT LUDLOW WA 983658001
PROJECT DESCRIPTION: SWAP OUT ELECTRIC WATER HEATER
Directions
To Site:
THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 10/3/2014.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: 7%' /` z33 '''r
FinalApproval: itf -far I ha, /l `�/�
BUILDING INSPECTION HOT-LINE 379-4455.
REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED.
Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday
HOT LINE AVAILABLE 24 HOURS A DAY
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DateAV_____1_ time received k-1 am /69 _ . _
Mon. TueS. .Wed:. Thur. d
BLD: 1 3 -310 . . Date:
OWNER: - - Contact Narne.
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/ I ADDRESS: 1`i C...-A ecury re,,f-, r c— Contact Number.360 c ES 7 1 35-5-
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.Foundation Plumbing - Framing Propane Tank echanioa
Setbacks Under-ground Framing Underground . Furnace
Footing Rough in Air seal • Above ground • Gas _____
Stemwall Hydronic Exterior shear Exterior lines Oil
Straps --- Interior shear Interior lines , Ducts q
.
Post Hole Ventilation Appliance•
Underfloor _ G as/wood stove
Man-Homes .
' -
Setbacks - insulation . V Final Inspection -=
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Foundation. • ,..,
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Block&Tie floor wall ceiling Address Posted
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Date /1 -1 1 'time received 102-3 9i pm -. Mon. MD Wed: Thur. -Pri.
• BLD: 1. 3 - 31 ° . Date: 1 (-7 '.2-- - • - .
OWNER: 12-e-r-e--r . . . Contact Name:.
ADDRESS: 7q cAeicevroi. re-- . .Contact Number.360 ,- '-'...-••-•‘:1;
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206
-
Notes: . -
Foundation Plumbing -Framing . Propane Tank Mechanical . .
Setbacks • Under-ground Framing Underground Furnace
Footing Rough in Air seal Above ground Gas
Stemwall 1-lydronic Exterior shear Exterior lines Oil
• Straps Interior shear Interior lines _
. Ducts f
Post Hole Ventilation Appliance•
Underfloor ,, - .Gas/wood stove
Man-Homes
Setbacks V V Insulation. . • Final Inspection
• Foundation- . -..1. • ,T-..
Block&Tie floor wall ceiling. • Address Posted
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•
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FWH ACQUISITION COMPANY LLC/DBA FOWATER HEATER COMPANY 15861
•
JEFFERSON COUNTY 9/17/2013
658276 PERRY 76.00
Please fax,email, or call with a copy of the permit or permit
number mailing the hard copy.Thanks!
Phone:425-636-7084
Fax:425-636-7055
Email:sthapa @fastwaterheater.com
76.00
FWH - PERMIT ACC 658276 PERRY
JEFFERS COUNTY • NO. 145421
1
DATE t,°(3/t 3
RECEIVED FROM ON ki' SI -ow-.
DESCRIPTION BARS# AMOUNT
CURRENCY
_� COIN
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$ O
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RECEIVED BY - TOTAL /..