HomeMy WebLinkAboutADR2009-00048 ,6e( 4 .
ADDRESS REQUEST
JEFFERSON COUNTY PERMIT CENTER
621 Sheridan, Port Townsend,WA 98368 (360) 379-4450
APPLICANT: Please fill out item 1 through 8. MYaslp4r. .1?R rson County Fee Schedule
ANew Ad dress H Correction ❑ Change ❑Review DIFF LEFT M.P. RIGHT DIFF
2. Applicant Name: /l, ] e r 0 krocsIt.
`
3. Mailing Address: _ -5 j„ L_, J, A GG
Town/State/Zip � d, : e0 g6�
4. Teleph e: W rk ,___. -5:-.6g..60 Home:
_
OP 5. Location: Attach a Detailed Drawing or Map.
Additional Fees May Be Required if More Than One
Site Visit Is Necessary
*******PLEASE FLAG YOUR DRIVEWAY.******* !�q `
Date Flagged: / / Flagging Color (( qCI� �C
Nine Digit Tax Parcel Number 7776 0 6 2 (o 0 LI Z / r 7
Plat Name Block Lot 4/
6. Road Name: 4 i JA , �J .,i PI
Is this a PRIVATE or C I "'' ".'""7 CLE ONE 375"
Nearest Cross Road: 346 ,3C
7. Neighbors'Address if Known: 33 3S6
Name/Address:
Name/Address: .3 6 3/y
8. ou Need To Construct a Driveway? a�� �g z
YE or NO CIRCLE ONE
9. Was This,Submitted With A Building Perm FIELD NOTES
YES off-- O) CIRCLE ONE . -1 � 1 P/ ies
SHADED AREAS OFFICE USE ONLY
New Address: 3/ *icy tea/ PIP- V
Postal District: ,/orJan/ D, , /
Real Milepost: • �� Road#: W `/
n o Left Right ' Fire District I Building Permit# O Plate Sent /4 /(6
1 Odd Even Date Paid /14/09 Check# 10_5(.0 Receipt# in(4'jc Date in Computers 24
3 122 .(012.2.1
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JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
ADDRESS REQUEST INSTRUCTIONS
o Complete the address request form in as much detail as possible. The most important
information to include is the complete name of the road where your property is located,
whether or not the property is in a plat, the nine digit parcel identification number and
the block/lot number. The fee is I --
o You must also attach a vicinity map or drawing.
o Use the survey ribbons provided to flag both sides of your driveway. If your driveway is
not in yet, mark the location where the driveway will be. You must apply for a road
approach permit if your driveway will connect with a county road.
o The address technician from the Permit Center will assign your address within 5 working
days. The technician will visit the site and determine the address according to the
nearest milepost distance from the start of the road.
o The red address plate will be sent to your current mailing address, as indicated by you on
the address request form, within one week to ten days. The plate is to be posted at the
end of your driveway and is to be clearly visible from both directions.
o The Permit Center will notify the appropriate postmaster, fire district and emergency
services of your new address.
****************************************************
ROAD APPROACH INSTRUCTIONS
o If you are constructing a driveway that will connect with a county road, you must apply for
a road approach permit. The fee is $alp)
o To complete the application for the permit, you will need to indicate the nature of work
and to include a simple sketch of the proposed work. You will also receive a survey
ribbon to mark the site.
o Once the permit inspector has visited the site, a permit will be drawn up and will include
the general conditions as well as any specific requirements concerning your site.
o The permit will be sent to you for you to read and sign. You are then asked to return the
permit to the Permit Center for the permit inspector to sign. You will receive a copy of the
signed permit. The permit is valid for a period of one year.
IF BOTH THE ADDRESS REQUEST AND THE ROAD APPROACH PERMIT IS APPLIED FOR
AT THE SAME TIME, THE TOTAL FEE $;:-.)-13 --
If you have additional questions, call the Department of Community Development at(360) 379-4450.
h‘home\pincntr\intodpw\instruct,doc 2/00
PLEASE ATTACH A MAP OR DRAW A DETAILED SKETCH
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APPLICATION FOR ROAD APPROACH PERMIT
Jefferson County Permit#
Department of Community Development Receipt#
621 Sheridan Street Check#
Port Townsend, WA 98368 Date Paid
(360) 379-4450
APPLICANT PLEASE PRINT OR TYPE ALL INFORMATION - CHECK BOXES THAT APPLY
0 Residential Approach Logging Approach 0 Temporary
0 Commerical Approach 0 Improvements Only 0 Approach&Address
County Road Name: Mile Post#:
(office use only)
I hereby designate
Applicant or Authorized Representative (Contractor) to act as my agent In matters related to this
Contractor Lic.# application for permit(s).
Mailing Address Owner Signature Date
City-State-Zip Code Parcel Number
Telephone No. Flagging Color& Date
ACKNOWLEDGEMENTS
By sighing the application form,the applicant attests that the information provided herein is true and correct to the best of their knowledge
and agrees to al conditions on the permit. I also certify that this application is being made with the full knowledge and consent of all owners
of the affected property. Any material falsehood or any omission of material fact made by the applicant/owner 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,judgment,coot costs,reasonable attorney's 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 inspection. This fight of entry shall expire when the County concludesthe application has complied
with all applicable laws and regulations. Access and right of entry to applicant's property shall be requested and shall occur only during
regular business hours.
The action or actions Applicant will undertake as a result 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 responsibility for adhering to and complying with the ESA.
The Applicant has read this disclaimer and signs and dates It below.
(APPLICANT OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
Updated 2/12/2008
Map Output Page 1 of 1
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FOR INFORMATIONAL PURPOSES ONLY-
Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its
correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. Mon May 18
12:06:47 2009
http://gisserver/servlet/com.esrLesrimap.Esritnap?ServiceNarne=ovrnap&ClientVersion=4.... 5/18/2009
Address Database Comparison Page 1 of 1
Enter Street Name String: Or Enter Parcel Number:
� _ Go
PUBLIC WORKS DB ADVANTAGE DB ASSESSOR DB MASTER
ADDRESS PARCEL ADDRESS PARCEL ADDRESS PARCEL ADDRESS PARCEL
292 MERRY RD 977700045 258 MERRY RD 977700038 292 MERRY RD 977700045 292 MERRY RD 977700045
314 MERRY RD 977700041 292 MERRY RD 977700045 314 MERRY RD 977700041 314 MERRY RD 972700041
350 MERRY RD 314 MERRY RD 977700041 350 MERRY RD 977700046 350 MERRY RD 977700046
373 MERRY RD 350 MERRY RD 97770004.6 375 MERRY RD 977700038 375 MERRY RD 977700038
375 MERRY RD 375 MERRY RD 977700038 392 MERRY RD 977700044 392 MERRY RD 97770444
392 MERRY RD 392 MERRY RD 977700044 394 MERRY RD 977700040 394 MERRY RD 977700040
394 MERRY RD 394 MERRY RD 2777.00040 398 MERRY RD 977700039 398 MERRY RD 977700019
398 MERRY RD 398 MERRY RD 977700039
For an address search, leave the parcel field blank.This is the signal that you want an address search. For a parcel search, enter the
nine digit parcel number. During a parcel search it does not matter what you have in the address box.
This tool uses a "fuzzy"search so If you enter"ZELATCHED"you will get all addresses that have that word in it. If you enter
"ZELATCHED POINT RD"you will only get the addresses that have that exact sequence of characters in it. This should allow you to
identify the source of many of the discrepancies between the data sources. For instance, searching for"AZALEA LN"gives only 5
addresses in the Advantage DB. Searching for just"AZALEA"adds another address because one was entered incorrectly as "AVE".
I purposely did not make a street picklist so you can have flexibility in your searches.
The far right column is the final list of addresses that will be loaded into the AS400. Clicking on the
address field will give you details about the address. On the details page you can click on links to get a map of the road or search
for more addresses on the parcel. Addresses that have a parcel that is not on our parcel map will not show up on this list as a
hypeHink.
There are many"dummy" addresses in the Advantage DB. Most of these have been filtered out by checking for a blank street
address number. The Assessor DB has been filtered by checking for null in the street address number field.
Let me know if this tool is useful and/or how it can be made more useful.
http://www.co.jefferson.wa.us/IDMS/DEVTEST/address.asp?street=MERRY+&parcel= 5/18/2009
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JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
ti '4 621 Sheridan Street • Port Townsend •Washington 98368
_ � 360/379-4450 • 360/379-4451 Fax
�.qs$N,gyp www.co.jefferson.waus/commdevelopment
Master Permit Application MLA: (1 1- I (Dr-i
Project Description(indu�e)sep rate s ss as- ssary):
Tax Parcel Number: / 7 77 C 0 C) F-6 Property Size: Z " square feet)
Siittee Address and/or Directions stto Property: /J� / /
400/yi 1-S�t->1 P / 0 ��-� l.G fly ' 14 V X�� r l
Property Owner(s)of Record: �J\ 6�c'r f �l'O G/ r/r'-a. )
Telephone: Fax: email:
Mailing Address: 7 7 3 //�G.■/ p7 i er /4,0 P /0r7-- // 4/d tt% G.... int-- y' 6,e
Applicant/Agent(if different from owner): T a' ' h Q hnc T/ (1 ou e ('s
Telephone: .� �� •• d Fax: 7 / -- y 2 email: /r)(?1 v,5(e /1/. '?(Ks. 4e
Mailing Address: /: Gt r /-s-di p-r--
What kind of Permit?(Check each box that applies
❑Building ❑ Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or Cj**
❑ Manufactured Home ❑ Modular ❑ Discretionary"D or Unnamed Use Classification
❑ Commercial* ❑Special Use(Essential Public Facilities)*"
❑ Change of Use ❑Boundary Line Adjustment
❑ Address ❑ Road Approach ❑Short Plat** MAY 1 4 2009
❑ Home Business ❑Cottage Industry ❑Binding Site Plan"
❑ Propane ❑Long Plat--
❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration*"
❑S rmwater Management ❑Shoreline Master Program Exemption/Permit Revisions'"
ite Plan Approval Advance Determination(SPAAD)" ❑Shoreline Management Substantial Development**
❑ emporary 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 Conference
Please identify any other local,state or federal permits required for this proposal, if known:LI DESIGNATION OF AGENT
I hereby designate 1314ri)Ar�r� / ( 2/ ; to act as my agent in matters relating to this application for permit(s).
—'�
OWNER SIGNATURE ` L.1,(j7i1 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 1
review and any required later inspections. Staffs a• ss artt)ig of entry will be assumed unless the applicant informs the Co my in writing at the
time of the applica's at he�' she wants prior not / ��
/! "
Signature: �„I�%' , - A � � Date: � 6 � I.
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-transf le resp sibility for adhering nd s:omplyin with the ESA. The Applicant has read this disclaimer a d signs d dates it below.
111111 /g� Y"�1 / d Date: C/J �``` / ) C
Signature: dl C A✓ ( �f7G 1/z �W✓ � 4
G:\Pe mitCcntcr\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc