HomeMy WebLinkAboutADR2009-00050 • 1P�.1D X0--1- (4-co RECEIVE') .
b\UA" 0-1- 3s_3 ADDRESS REQUEST
JEFFERSON COUNTY PERMIT CENTER t
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621 Sheridan,Port Townsend,WA 98368 (360) 379-4450 , ,.,lt, r,,,�,
APPLICANT: Please fill out item 1 through 8. Fee as per Jeffersdn County Fee Scheduae
1 ❑ New Address ❑ Correction ❑ Change ❑Review L '. It
2. Applicant Name: i1\a OW\ 0 C N�c\ \ i}
3. Mailing Address: 3 I 1_0 yJ v-L, CIG L R4
Town/State/Zip �Oie..i icklk 1 v �01&'33q N,r .` ..:
4. Telephone: Workt �Q&y U. �Home: ytl �i3)(
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5. Location: Attach a Detailed Drawing or Map.
Additional Fees May Be Required if More Than One
Site Visit Is Necessary
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*******PLEASE FLAG YOUR DRIVEWAY.*******
Date Flagged: Co i'-1 /07 Flagging Color }'ZED_61'G.n�C .a
Nine Digit Tax Parcel Number Cj3O-700—3 Oa. 30 L/
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Plat Name E V Wrzc Block 3 Lot Sy—_-..13:t`
6. Road Name: . ,N� • fi 6•� .
Is this aRIVA DI er " "_' .ad? CIRCL ONE
Nearest Cross Road: ., � i 1
7. Neighbors'Address if Known: O. 127
Name/Address: O '`, -"- ,' ,
Name/Address: :• 2 Z
8. Do You Need To Construct a Driveway? , '''1 d 3 ,: ,,DZ
YES or NO CIRCLE ONE b'cavaV',P11 CNS C� t,�
9. Was This Submitted With A Building Permit? I�
YES o 0 CIRCLE ONE - ///J
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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 $ j 5 y
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 e p ostm
aster, 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 $ 15 2 .
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 $ /52
If you have additional questions, call the Department of Community Development at(360)379-4450.
h:lhomelpIncntAinfodpvAinstruct.doc 1/1/05
Map Output Page 1 of 1
ArcIMS HTML Viewer Map
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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 respec
in this map is limited by the method and accuracy of its collection. Thu Jun 04 11:19:24 2009
http://gisserver/servlet/com.esri,esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.0... 6/4/2009
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
103 LUPINE ST 001093023 103 LUPINE ST 001093023 15 LUPINE ST 001093021 103 LUPINE 5T 001093023
135 LUPINE ST 1093024 135 LUPINE ST 001.093024 37 LUPINE ST 001093022 1.35 LUPINE ST 001093024
15 LUPINE ST 001093021 15 LUPINE ST 001093021 103 LUPINE ST 001093023 15 LUPINE ST 001093021
32 LUPINE ST 950 700 401 37 LUPINE ST 001093022 135 LUPINE ST 001093024 32 LUPINE ST 950700401
37 LUPINE ST 001093022 37 LUPINE ST 001093022
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
hyperlink.
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=LUPINE+ST&parcel= 6/4/2009
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APPLICATION FOR PERMIT
Jefferson County No Rill-i ktl G�. Permit# "� t4'
Department of Community Development m O l (/ {
621 Sheridan Street r+- J�'t GSS 1� Cheek#
Port Townsend,WA 98368 Date Paid
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(360) 379 4450 or 1-800-831-2678 Fee ;19 °;,
APPLICANT PLEASE PRINT OR TYPE ALL INFORMATION -CHECK BOXES THAT APPLY
ElRoad Approach ® Road Approach Permit&Address El General Permit
Utility Class A El Utility Class B El Yearly Class A
Fee: 20%of Class B
County Road Name: 1-.IlIpy 14 . lvll)'e. a #. " ``
1-.L tltl (office use only)
Intended use of County Right-of-Way is to construct, operate and maintain a:
jbti1VtAkI S% 4 e. Re3∎01eNcZ Thrn
P \\ 1 S $s INNZ)11 I hereby designate
Applicant (Owner, Utility,or Authorized Representative.) to act as my agent In matters related to this
application for permit(s).
\ ci. , CKiL\cxA M aii cl‘ra .d Cs1O0
Mailing Address Applicant Signature ate
P o fi 1 A look ,VI% '\V2Z �ECEF\7 ; 0-. 700- ..z o3.-.3oq
City-State-Zip Code Parcel Number
'3.,Q., - 3(. I4✓ X2 i? . Uk' CAA . . 1y o°l
Telephone No. Flagging Co Date
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ACKNOWLEDGEMENTS
By signing the application form,the applicant attests that the information provided herein Is true and correct to the best of their knowledge
and agrees to all 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,court 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 right of entry shall expire when the County concludes the application has compiled
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 N 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 h s ad this disclaimer and signs and dates it below.
(APPLICANT OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE
MAKE CHECK PAYABLE TO JEFFERSON COUNTY
Updated 12/19/01
All utility providers conducting work within County Rights-of-Way shall obtain a utility permit as follows:
Type A Activities shall include installing less than five new utility poles or replacing any utility poles, installing
short side utility services more than two feet off the edge of pavement, individual service connections with less
than 200 feet of trenching,and removing 2 or fewer panels of Portland Cement Concrete sidewalk. Utility
providers conducting Type A activities within County Rights-of-Way shall obtain an annual utility permit. Upon
obtaining an annual utility permit,all utility providers shall provide written notification before starting any Type
A activities and must provide written certification within ten (10)calendar days that the work was done in
conformance with this Chapter.
Type B Activities shall include individual service connections with more than 200 feet of trenching, all roadway
crossings, installing underground vaults, constructing splice pits, attaching to any bridge structure,installing main
lines, and all other utility activities within County Rights-of-Way. Utility providers conducting Type B activities
within County Rights-of-Way shall obtain an individual utility permit for each Type B activity.
Exempted Activities. Utility providers conducting the following exempted activities within County Rights-of-Way
shall not be required to obtain a utility permit: stringing cables on utility poles and associated maintenance
thereof,accessing and maintenance of existing manholes, handholes, pedestals,closures and vaults,and replacing
above-ground meters, transformers,closures,and pedestals,and performing emergency work.
PLEASE ATTACH A MAP OR DRAW A DETAILED SKETCH
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Updated 12/19/01
PERMIT TECHNICIAN'S REPORT
(For Department use.only)
Reviewed in field on Reviewed by
(Date)
Preliminary inspection report:
Site distance North: South: East: West:
Posted speed limit:
Follow-up inspection report reviewed in field on: By:
(Date)
Comments:
Final inspection reviewed on: Reviewed by:
(Date)
Comments:
REV EIATT4'
JUN - 42
JfffEI1 N COOP/ BCD
Updated 12/19/01