HomeMy WebLinkAboutBLD2014-00192 BUILDING PERMIT APPLI*ION BLD14-00192
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD14-00192 Received Date: 6/4/2014
SITE ADDRESS: 107 EDGEWOOD DR
PORT LUDLOW, 98365
OWNER: LISA M GATLIN TRUSTEE PHONE: 360-437-8811
LISA GATLIN TRUST
107 EDGEWOOD DR
PORT LUDLOW WA 98365-9220 EDGEWOOD VILLAGE
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 948200013 Section: 20 Township: 28 N Range: 01 E
CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901
221 W CEDAR
SEQUIM WA 98382
Contractor's License AIRFLI*206DG Expires 4/25/2016
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION ADD DUCTLESS HEATING PUMP SYSTEM
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION ADD'L: HEAT TYPE:
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: APPROVE
,
Prop: Prop: AI'"b ,@�. ,E7 E
Total: Total:
JUN 34254
Routing Date:
Jefferson County O
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $228.00 MEB 06/03/14 148758
Total: $228.00
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4w �� JEFF SON COUNTY • P Lb y' �c‘1-2-
14 DEPARTMENT OF COMMUNITY DEVELOPMENT
I-4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
,� O, O� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
2Ad eiALauss \-LQ .F3.,A rivca)s 5J \
Tax Parcel Number: q 4-820Cn I
3 Property Size: (acres/square feet)
Site Address and/or Directions to Property:
101 6d Fi€ l Dn�. �br1- lat.a■cnu) , t,.,.)� °{ ;
Property Owner(s of Record: Uk.)i 1,arc4 '4- L " (..A.r
Telephone: 431 ' 'bell Fax:
email:
Mailing Address:
Applicant/Agent(if different from owner): it F10 He -writ-1C%
Telephone: 34O-tp3 -gage l Fax: (P53^ 3R"i i_-J email:etteJf't
Mailing Address: 22-1 W. Cedar Si @Sr1r-�lo r�,�p,yt
• SeQwM ,wA 88302
What kind of Permit?(Check each box that applies
❑Building 0 Critical Areas Stewardshi i • _-
O Demolition Permit ❑Variance(Minor,Major or,R rr reritivE
5] Single Family O Garage Attached/Detached 0 Conditional Use[C(a),C( i'JJ I�� I�7 VV
❑ Manufactured Home ❑ Modular ❑Discretionary"D"or Unnamed Use Classification
❑ Commercial" ❑Special Use(Essential Publir�Facilities)"
❑ Change of Use )
❑ Address ❑Road ❑Boundary Line Adjustment' JUN - '? 2014
❑Home Business Approach 0 Short Plat"'
❑Cottage Industry ❑Binding Site Plan•" i J 'iii
❑ Propane ❑Long Plat" I N f nor
❑Sign ❑Planned Rural Residential
tiFY� r WMATANil "
❑Allowed"Yes'Use Consistency Analysis i ,i r ent>`•
❑Stormwater Management ❑Plat Vacation/Afteratirrt -
❑Shoreline Master Program Exemption/Permit Revisions"
❑ Site Plan Approval Advance Determination(SPAAD)• ❑Shoreline Management Substantial Development••
❑Temporary Use ❑Shoreline Management Variance
❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment •
`May require a Pre—.application Conference ❑Tree Vegetation Request
**Requires a Pre-Application
Please Identify any other local,state or federal permits required for this proposal, if known::�Conference
I hereby designate 1-111- �1 C7 }1ear•n DESIGNATION OF AGENT
to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE '?/,/.t..6d61 c -
. Date:
By signing this application form,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
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit
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 appt lion that he she wants prior notice.
Signature:
Date: �5
k 1
The action or action Applicant will undertake as a result of the issuance of this
permit may negatively
endangered species and could lead to a potential"take'of an endangered species are impact in th one er more known as the
e
`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-trans f r ble ressp_onsib'.ty for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date: (5 i —N
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JEFFERSON COUNTY DCD NO. 14J8758
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Screen: 01 • REAL PROPERTY MASTER Mode: INQUIRY
Auto Roll : OFF
Parcel # 000948200013 Geo Cd 282120007231
EDGEWOOD VILLAGE Nbhd Cd 3350
LOT 13
Loc ID
* Taxpayer Cd GATL 2000 GATLIN TRUSTEE, LISA M T/P Chg Dt 1/20/1999
* Title Owner T/P Chg Usr JODI
Tax Code 0231 Status TX TAXABLE Land Use 1100 RES-SINGLE
Affidavit 86070 Vol/Page / C/U Code
COMPLETE ADDRESS WINDOW
Taxpayer
GATL2000 LISA M GATLIN TRUSTEE
LISA GATLIN TRUST
107 EDGEWOOD DR
PORT LUDLOW WA 98365-9220
Search Key
CMD 6: End Window CMD 7: End of Job
AIR FLO I-IEATING COMPANY Ii Page 1 of 2
Aft Washington State Department of
4 Labor & Industries
AIR FLO HEATING COMPANY INC
Owner or tradesperson 221 W CEDAR
BEQUETTE, MARK A SEQUIM, WA98382
360-683-3901
Principals CLALLAM County
BEQUETTE, MARK A, PRESIDENT
BEQUETTE, SANDRA A, VICE PRESIDENT
BERSON, JOEL R, SECRETARY
FULLAWAY, MICHAEL
(End: 04/01/2010)
Dot business as
AIR FLO HEATING COMPANY INC
WA UBI No Business type
600 347 761 Corporation
License
Verify the contractor's active registration / license/certification (depending on trade) and any past violations.
Construction Contractor Active.
Meets current requirements.
License specialties
Heating/Vent/Air-Conditioning and Refrig
(HVAC/R)
License no.
AIRFLI*206DG
Effective—expiration
03/07/1980—04/25/2016
Bond
CBIC $6,000.00
Bond account no.
SI5215
Received by L&I Effective date
02/05/2010 02/01/2010
Bond history
Insurance
American Hallmark Ins Co of Te $1,000,000.00
Poitcy no.
44CL483619
Received by L&I Effective date
04/18/2014 04/25/2014
https://secure.lni.wa.gov/verify/Detail.aspx?UB1=600347761&LIC=AIRFLI*206DG&SAW= 5/8/2014
• •
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#: BLD14-00192 Received Date 6/4/2014
SITE ADDRESS: 107 EDGEWOOD DR Issue Date 6/4/2014
PORT LUDLOW, 98365
APPLICANT: LISA M GATLIN TRUSTEE PHONE: 360-437-8811
LISA GATLIN TRUST
107 EDGEWOOD DR
PORT LUDLOW WA 98365-9220
SUBDIVISION: EDGEWOOD VILLAGE Block: Lot:
PARCEL NUMBER: 948200013 Section: 20 Township: 28N Range: 01E
CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901
221 W CEDAR
SEQUIM WA 98382
Contractor's License AIRFLI*206DG Expires 4/25/2016
OWNER, LISA M GATLIN TRUSTEE PHONE: 360-437-8811
if different: LISA GATLIN TRUST
107 EDGEWOOD DR
PORT LUDLOW WA 98365-9220
PROJECT DESCRIPTION: ADD DUCTLESS HEATING PUMP SYSTEM
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 6/4/2015.
REQUIRED INSPECTIONS:
Installation per Manufacturer Specifications/CO2:
Tank/Line/Appliance:
Final Approval: 6/i</1 S�
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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