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Home My WebLink AboutSUB2010-00018 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT UNIFIED DEVELOPMENT CODE TYPE I LAND USE PERMIT APPLICANT: ELIZABETH B GIBLER 728 ADELMA BEACH RD PORT TOWNSEND WA 983689282 DATE ISSUED: December 14,2010 DATE EXPIRES: December 14,2011 MLA NUMBER:MLA10-00344 PROJECT PLANNER:Michelle Farfan PROJECT DESCRIPTION: LAST WILL & TESTAMENTARY DIVISION PROJECT LOCATION: Parcel number 901 051 003 & 901 042 006, Section 5, Township 29, Range 1W, WM, located at 730 Adelma Beach Road, Port Townsend 98368 CONDITIONS: 1.) To help prevent seawater from intruding landward into underground aquifers, all new development activity on Marrowstone Island, Indian Island and within 1/4 mile of any marine shoreline shall be required to infiltrate all stormwater runoff onsite. 2.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 3.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated. Should buffer disturbance occur during construction, the Unified Development Code (UDC)Administrator shall require replanting with native vegetation. No alterations shall be made to the Landslide Hazard Area or its associated buffer without prior authorization by the UDC Administrator. 4.) Prior to and during approved construction activities, the perimeter of the landslide hazard area buffer shall be marked with a temporary sign. The sign shall be placed in such a manner that it can be directly observed from the construction area. The sign shall contain the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter Existing Vegetation." 5.) All construction activities shall not encroach upon the landslide hazard area buffer. This includes the storage or preparation of materials. 6.) The applicant shall permanently separate the boundary of the Landslide Hazard Area Buffer from the remainder of the subject property through installing logs, trees, a hedge row, or any other prominent physical marking approved by the UDC Administrator. 7.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. 8.) Approval of this Testamentary Division does not guarantee the approval of any future county permits and/or approvals. 9.) At such time that a permit is applied for on these two parcels, a current geotechnical report shall be submitted to the county for review. 10.) At time of land disturbance and/or permit application, the parcels shall be subject to the current Codes and requirements in place at such time of development. FINDINGS: 1.) The Administrator finds that this application complies with applicable provisions of the Unified Development Code,all other applicable ordinances and regulations, and is consistent with the Jefferson County Comprehensive Plan and Land Use map. 2.) The application was reviewed by the Jefferson County Department of Community Development staff on October 4, 2010 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: conservancy shoreline designation; stable, unstable, & unstable recent slides shoreline slope stability; eagle; seismic; slight, moderate & severe landslide hazard areas; SUSC aquifer recharge area; coastal SIPZ. 1 3.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 4.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to grou dwater aquifers. 5.) Geologically Hazardous Areas in Je erson County are characterized by slope, soil type, geologic material, and groundwater that may combine to cr ate problems with slope stability, erosion, and water quality during and after construction or during natural e ents such as earthquakes or severe rainstorms. 6.) Marine shorelines and islands are s sceptible to a condition that is known as seawater intrusion. Seawater intrusion is a condition in which the s ltwater/freshwater interface in an aquifer moves inland so that wells driller on upland areas cannot obtain fresh ater suitable for public consumption without significant additional treatment and cost. Maintaining a st ble balance in the saltwater/freshwater interface is primarily a function of the rate of aquifer recharge (primaril through rainfall) and the rate of groundwater withdrawals (primarily through wells). The Washington Dep rtment of Ecology is the agency with statutory authority to regulate groundwater withdrawal for individua wells in Jefferson County. New development, redevelopment, and land use activities on islands and in close proximity to marine shorelines in particular should be developed in such a manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to the maximum extent possible by infiltrating stormwater runoff so that it recharges the aquifer. 7.) The parcel is located within a coastal SIPZ(seawater intrusion protection zone) according to the County GIS map. There are voluntary and mandl:tory measures identified in the Jefferson County Seawater Intrusion Polic (Resolution 44-22, effective Septem•er 23, 2002) that apply to well drilling proposals and building permit applications on existing lots of recor•. A Coastal SIPZ is defined as: all isla ds and area within one-quarter mile of marine shoreline, but no history of chloride concentration above 100 m./L in groundwater sources within 1000 feet. 8.) Jefferson County determined that thi. proposal is categorically exempt from review under the State Environmental Policy Act(SEPA) pu uant to WAC 197-11-800(2)(j). 9.) This approval is for a Testamentary n ivision only. Any future permits on this site are subject to review for consistency with applicable codes a • ordinances and does not preclude review and conditions which may be placed on future permits. 10.) The parcel has been designated as R 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 11.) NOTICE: This permit does not excu•e the proponent from complying with other local, state, and federal ordinances, regulations, or statutes -pplicable to the proposed development, but consistent with RCW 90.58. Development pursuant to this permit hall be undertaken subject to the applicable policies and performance standards of the Jefferson County S oreline Management Master Program and the Jefferson County Unified Development Code. If during excavation or development f the site an area of potential archaeological significance is uncovered, all activity in the immediate area shall b halted, and the Administrator shall be notified at once. The Federal Endangered Species A t rules to protect threatened Chinook and Summer-run Chum salmon became effective on January 8, 2001. Bull trout have been listed as threatened since early 2000. Under the ESA, any person may bring lawsuit a ainst any individual or agency that"takes" listed species (defined as causing harm, harassing, or damagi g habitat for the listed species). In addition, the National Marine Fisheries Service can levy penalties. All areas in Jefferson County are included as"critical habitat"for a listed species. Development of property along any arine shoreline, freshwater shoreline, or floodplains could harm habitat if protective measures are not taken. o minimize the potential to damage habitat, all property owners developinc adjacent to marine shoreline, freshw ter shoreline, or floodplains are advised to do the following: -All development activities should a .id unstable slopes, wetlands, and forested areas near surface waters - Remove minimal vegetation for site development, especially large trees -Allow trees that have fallen into su ace waters to remain there - Infiltrate stormwater from buildings :nd driveways onsite through drywells rather than discharging directly into surface waters or roadside ditches Any individual, group, or agency can .ring suit for a listed species"taking", even if you are in compliance with Jefferson County development code-. The risk of a lawsuit against you can be reduced by consulting with a professional fisheries habitat biologi , and following the recommendations for site development provided by the biologist. For more information, contact the National Marine Fisheries Service in Seattle, or the U.S. Fish and Wildlife Service. APPEALS: Pursuant to RCW 36.70C,the applicant or any aggrieved party may appeal this final deasion to Jefferson County Superior Court within twenty-one (21) calendar days of the date of issuance of this land use deasion. For more information related to judical appeals see JCC 18.40.340. I 110 UDC A• �t MLA10 '� 3 of 3 I bd I �. ill ill -Pk Nm C7 C') S I S - 1 m CJI I op I NN I iii 1 n - Z 7 - j J' �• �\ s I �`'0 % °` / nS ) I () 1/4p ," I ,` I s -- i S I rS • 8 i I I ' •' �pmNNo i � 1 I ------.�-4.4 to --- .sWER --- M 1� --rt--- A eE' Cy R I i i � 1 W�Do o� � RD ,1 moo o X _. 0H 0 0Da Xao ,,,.111 O CO R 16) \`� '' v u P xrno Xo� •oma-• jr�xo o C O pAp � I 0- , , qo^ N S O O p�- o Q \� V vW(O I� mO o4�RR ��q o o *ter°° I (41 �\ 78 o a� < m 4e o I cti 6� // / �1 m Q . II o r// r If) v p • o I I -1O RD • Op I ❑ to cn r- o II a XI m� -I I I WJ N m7471 I '1 ' H 'A m I m .o z x � m I I (1) > c.,J n o I •° N 0 x I I = I NJ I- • • CO R' p I 0 c,, Dw � < H I /-II ❑ Xvo -Iy I --{ X W 1 T �>o r-1� V X I X .ZJ I I f X-c,, 0 0 I m ' W III > �Q•0 1R.o o8 �, 1 `1 •NX OXO DO I0). 1 1 p A O 2 O I I � I_ _ _ i I W XI I I N OO 70.38 I G® V YT I 1 1 ^) H 0 N / I o - I / ❑ -' C/' o X ^0 o r CO hill.111111\.... • //' D �` 78 I /// /� / 80.005 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Port Townsend WA 98368 MEMO TO: s FROM: Michelle Farfan, Associate Planner, FHM Lead mfarfann,co.jefferson.wa.us 360-379-4457; fax 360-379-4473 DATE: I l (0/1/ _ SUBJ: 6 (1,6r! ��, � V ( 1 (S Comments: QJ1Q� cPS lertCd c oC,I)'i' ' PIA p pq h V1t ��45oN c JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT ti 4 621 Sheridan Street <q'? .$ Port Townsend, WA 98368 October/ 2010 Al Scarf, Director Dear Re r, T W.-)c A- RE: MLLA10-00344 Jefferson County has forwarded the attached application to you for review and comment because your agency is responsible for determining compliance with state and federal requirements or may otherwise be affected by the following proposal: LAST WILL & TESTAMENTARY DIVISION Location: Parcel number 901 051 003 & 901 042 006, Section 5, Township 29, Range 1W, WM, located at 730 Adelma Beach Road, Port Townsend 98368 2s Comments must be received within fourteen (14)calendar days or by October23,2010. If no written response has been received within fourteen (14)days, your agency will be presumed to have no comments. If necessary,the UDC administrator may grant an extension of time for comment. Please contact at (360)379-4450 if you desire an extension of lime or have additional questions regarding this proposal. Thank you in advance for your attention to this matter. Sincerely, IdA 11116. c: , October 14, 2010: Reviewed the Last Will & Testament of Elizabeth Gibler. It serves to divide the property by testamentary division. Thus, in accordance with RCW 58. 17.040(3) it is exempt from the Subdivision Statute of 1969. The division of land should go through. n f /l/A141fC/'� L /4 David Alvarez Building Permits/ Inspections Development Review Division Long Range Planning (360) 379-4450 FAX: (360) 379-4451 4ox cow $(R7 n0 JEFFERSON COUNTY r DEPARTMENT OF COMMUNITY DEVELOPMENT �" 621 Sheridan Street • Port Townsend •Washington 98368 $ 360/379-4450 • 360/379-4451 Fax N ° www.co.jefferson.wa.us/commdevelopment ('1 Master Permit Application MLA: ( 0 -3' 4 Project Description(include separate sheets as necess ry): LF- Ua1 L - T� atinPm ry -D1'?i IND Tax Parcel Number: 901-042-006, 901-051-0aW, Property Size: (acres/square feet) Site Address and/or Directi2N-torpy3 Property Owner(s)of Record: Elizabeth B. Gibler, deceased Telephone: Fax: email: Mailing Address: Applicant/Agent(if different from owner): Edward M. Milbourn, Personal Reprsentative, Estate of I Telephone: Fax: email: Elizabeth B. Gibler Mailing Address: 5251 S 200 E, Greenfield, IN 46140 What kind of Permit?(Check each box that applies 0 Lot or Road Segregation ❑Building 0 Critical Areas Stewardship Plan O Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home • .❑ Modular - ❑Discretionary"D"or Unnamed Use Classification O Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach ❑Short Plat** 0 Home Business ❑ Cottage Industry ❑ Binding Site Plan"* c L. I J : Jr ❑ Propane 0 Long Plat** ❑Sign -- 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration" ❑Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development" ❑ Temporary Use ❑Shoreline Management Variance 0 Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 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: DESIGNATION OF AGENT I hereby designate Richard L. Shane f- ' to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ._ = Ji*.aAODater 7-.ZoWykr2 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 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 inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the appl' at he or s.- i. , pri.� -. Signature: ., � . / f /La . /i Date: 7 2 "2c / 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-tran . r onsibility f r a n to .n. ,. :lyingith •.- ESA. The Applicant has read this dis aimer and signs and dates it below. Signature: lie Date: "' :2c-Ve:5" C;APemutCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Annlirarinn s_79_nR dr,r, S TATE\u ,W>A SlH,I IT! P �TMENT OF`HE•A= � � .r{ t �ew. +z� .tl;: 1• �k'- 6.-4,,..v,..,,.. �A 4'.0444';''' +^ ;",'� r ^.l v .�»�.-`�w3 ..1. �m..�*•n t ,q"ifs .�: L !r!{s ,-- Local Foe Number a(0 '- 'Washington State Certfftcate of DeaTh State File Number 1.Legal Name,n .>A rich t Fhrs4 'Middle tAST Softti 2.Dead[Date ' t Elizabeth Ursula G IBLER Oct 19, 2QQ,Y .Sex tom) '45.Age-Last Bmhday 4b.Und,re'l Year 4c_ Under�t Day . 5.'Social SecuttyNteeb@i 6.Cduntyof Death r_ Female 82 mc"'"* " - Dais 4i�rsiaaw� _ ,: 31130L429.3 3, - Jefferson .Birthdate B .Birthplace:(City,frown,or Dainty) 8b.(State"or Forefgn Country) ` 0.Decedent's Education - - Aug., 14, 1927-`. Brooklyn - Heir"York Materia Degree . 8.Was Decedent of Hispanic Origin?(Yee or No eyea,specfy. ' 1,Decedent's, ` RIs .. ,. 12.Was Decedent alprin u 5. No Caucasian amadFe�? No y,,1 y 3a.Residence:Number and Street leg,q24 SE 5'"$t)Olden.. No) 13b.City or Town ,l rt 728 Adelina Beach Road Porgy Townsend 13c,Residence: '13d.TobaiRetereation?lame(tep�teek0'13e.State or Foreign Country 1$LZip Code a 4 ' ' 13g.Inside City Limits? Jefferson E "WA Wash ngton 58.368 ID yes Epp :..,sq uck 14.Estenated length of Bmeat residence. 15,Madtat Status.at Time of Death' •11.Surviving Spouse's or Demeetic Patfler'4 Neni teNe name prbrto first maniaye) - 9 YearsWidowed N/A, > '-Y 17.Usual dccuM pation(Indicate type, work dorie�during'most of woddng life. (Pu not use aeimeol:18.Kind of Business/Industry(Do net use Cdrpeny IMme ' - Homemaker Own Home ,Ii 9.Father's Name fFitst.PAM*.Last.SuON) 20.Mother's Name Before First Marriage(F,kat Middle,Last) tltt Pio-rian Hartford Bran Elizabeth Mills, ' 01.Informant's Name „22.ftelatfdnshlp to Decedent 23.Mailing Address: eshb.•and SIMS, RFD No. cty or Tons stn. ZS Maggie Kelleher Daughter 730 Adelma Beach Rd. , Port Townsend, WA 98368, 1 r.4.Piece or Death:If Death Otcur.ed m a nnsPea): Place of Death,if Death Occurred Sornewhere Other than a Hospital: N/A Daughter's Home r 5.Facility Name(If not a facility,give number&street or location) 26a.City,Town,or Location of Death 26b.State 27.Zip Code - .' 730 Adelma Beach Rd. t ,, .r , y ,;'Po`rt•,,Townsencl' WA 98368 ' ;1 r 8.Method of Disposition : Plate ofpk atDisposition(Nammry e of ceete ,Qeinelory,ratter place) 30.Location-City/Town,and State u. Cremation I osecr 41torp1 -1 Port Townsend, WA .1.Name and Complete Address of Funeral Facility it ..wry 5,i 4,�., ,7 3,2,Date of Disposition e "Kosec Funeral Home, 1615 rk e'a Dr a'Rohl°[, Totingett1, IA` $386$'1, Oct. 20, 2009 4 •3.Funeral Director SlgnahtroX % 'r . ' / "/��, ''',�.-'�" / P -. 'Si Cause of Death .''7nenettlons.and exantplia) ' . . Enter the ctlain-of events-diseases,injuries,or complications-that direct -ed the death. DO-NOT enter terminal events such as cardiac wrest,respiratory,arrest,or entncular fibrillation without the etiology. DO NOT ABBREVIATE. •.Pr-.dintnat dries If necessary. 9 ' interval between Onset&Death IMMEDIATE CAUSE(Flnatdtsease or { /' .< -.ndibon resulting in death). a, Q�"C4� � - 11 _ CR N�',��' ' - 0�� •a' Dueto Corea a equenw of)' )eternal between Onset&Death 1nequentlally list.conditions,iif any,leading b. o the cause listed on line a.'Enter the Due te(a es a senseg,mnoe of): " . n erval between Onset&Death . NDERLYING CAUSE(disease or injury - )t : -3 hal.initiated the events resulting in c, tl. .. -a eath)6AST ---7-7------=-A, , - ( `iL7' �7 -_. (w eaa oo,tae4trenae oQ:. - _ interval between onset Death X ilVn "'■5.Other significant conditions contributing to death but not resulting in the underlying cause given'above 36.Autopsy? 37.Were autopsy findings alienable to '3 n / r.- completethe Cause of Death? I i 7Q��2vlSt0 lel 1�1>lpsl ff✓.� ��eqf� r - ❑Yes W No d Yea ❑tjo ....I.%8.Ma r e of Death 39.If female/ -40.Did tobacco use contribute zn Ei Natural 0 Homicide ISI Not pregnant within past year 0 Not pregnant.txapregnant within 42 days before death to death? ' 0 Accident 0 Undetermined 0 Pregnant at time of death El Not pregnant,but pregnant 43 days to 1 year before death g:Yes - 0 Probably 0 suicide ❑Pending ,, 0 Unknown If pregnant within the past year o 0 Unknown ' -1.Date of Injury niwoerm n 42.Hour of Injury(24hrs) 43.Piece of Injury(e.g.Decedent's have construction site,restaurant,wooded area) 44. Injury at Work? _ ❑yes- 0,No [funk 5.Legation of Injury: Number A--sumer Apt No / M or frown County: State: Zip Code.4: •.Describe how injury occurred - 47.If transportation Injury,specify: ❑.Diver/Operator' ❑Pedestrian ,.1<,, _ ,,,, ❑Passenger ❑S3lhef(SPS . '8a.o a rtiafyln9.� y �p�a1tt1�ya of k iowtedga death occwe4 aT the lei bate,and .b44i7 .Medical Exam)nerlCoroner-On Inc bass of euamir�atlon,an0%r roves[ Ilon,in my v� 0 4 f_ opinion.death occurred at the time,dale,and plata and due telhe dowels)an manna,slated tali _ - : 9.Name and Address of Certifier-Ph pan,Medical Examiner.«Coron 50.Hoax of Death(24hrs) - 1 - Claus H. Janssen, 34 Sheridat -Ave. r't...11:a”'‘..”...‘T'T'1;5 WA 98368 0530 Hours \ l .t.1 Name and nee of Attendlre7RhyskJanyotherthan CerO6er(Type• :opt e,;rF , ,:'. 52.Date,Signed I to/'24 e 3 Title of Certifier Q I91b ' ter, rt j t!# ,KI.Licetfse Nunlbec ...sea { r_• Fifa Number 56,Was cabs refected to MFJCororre�t f M.D sacra ..A rasa ' ..e. A - ❑Yes ®No `�'-' re, 7 4 stray Sign e, ,. _w:. �a�i r` aha 59 Dak Receivetl tM%wavrvvl s !�h ' St►a, w IV-I14iJ •9, ri ridme0tjS14, V r t . , 6 „5 A >f-h f Aha„ 01003(5)99) : Cs. I ,,: IfJp .,� .... .................................. A n,W AtL l L..t.s.tais 4.P,eitts r WWI A 1 uw,.,u• •^ ..[ •^•"am uatta tut atte ,� eta.^. 1 ,.....S/99),ILU-t` I�fcr,§) EsEI -i C�PY 6 TME RE O'Rta`kt�•FI I.*lilierNT R•F6R a AL�f fS1:;19.a lki C7E.R`TNFIEio•C®PIES CM'S T.HA'ETHE 0.56fe LVEkA,L>`�'; • Center far Health Statistics • 1t°vudro ,: -��1..�-u,, Affidavit for Correction P.O.Box 9709 Heal thOlympia,WA 98507-9709 This is a legal Document. Complete in ink and do not alter. (3sm 236-4300 -STATE OFFICE USE ONLY • State File Number Fee Number 1 Initials Date Affidavit Number • Use the section below for requesting any changes on-the record. • Record Type: 0 Birth i_ Death 0 Marriage 0 Dissolution 1. Name on record: 2. Date of Event: 3. Place of Event: (City or County) 4. Father's Full Name (For Birth): (Husband for Marriage or Dissolution) 5. Mother's Full Name (For Birth): (Wife for Marriage or Dissolution) The Rec)rd is Incorrect or Incomplete as follows: The Record now shows: The True fact is: 6. 7. - 8. 9. 10. 11. 12. • 13. -- 14. I represent the person as: CI Self El Parent ❑Guardian El Informant Telephone Number: 0 Funeral Directir 0 Other (Specify) I declare under penalty of perjury under the law of the State of Washington that the forgoing is true and correct. 15. Signature: 16. Date: 17.Address: - All vital records are registered as received.An item may be changed by affidavit only once.Subsequent changes must be made by court order.The incorrect certificate must be returned within one year of the date it was issued to receive-a replacement copy free of charge. All changes must be established by documentary proof submitted with the affidavit • Examples of documentary proof: Certificate of Naturalization Medical Record School Record Hospital Records Military Record (DD-214) Voter's Registration Card (if it bears an - Insurance Records Birth Record effective date) Marriage/Divorce Recoras Passport Allen Registration Card(front and back) Birth Certificates: • 1. Only a parent,legal guardian(if the child is under 18),or the adult themselves(if 18 or older)may change t.le birth certificate. 2. The proof(s) must match exactly the asserted true fa:t(s).For example,if the affidavit says the name is Mary Ann Doe,then the proof must show the name to be Mary Ann Doe.Mary A. Doe or M.A.Doe does not prove the name is Mary Ann Doe. 3. Proof must be five(or more)years old or have been established within five years of birth. 4. Up to age one,the parent(s) or legal guardian may change the child's last name with an affidavit for correction.provided: - This is a one time only change.Subsequent changes will require a certified copy of a court ordered name change. - The new last name may be the mothers maiden name or father's name(if present on the certificate)or any combination of the two. - After age one,last name changes require a certifieyl copy of a court ordered name change.Minor spelling Changes may be made with an affidavit and documentary proof. 5. Parent(s)may change their child's first or middle name by completing and signing an affidavit for correction(until their child's 18th birthday). 6. This affidavit cannot be used to add a father to a birth certificate. (Use the paternity affidavit-form DOH/CHS 021) Death Certificates: 1. Only the informant,the funeral director,or executors administrators(if evidence confirming such position is presented) may change the non-medical information. 2. The medical information(cause of death) may be ch inged only by the certifying physician or the coroner/medical examiner. 3. If it is less than sixty days from date of death please ;ontact the county health department where the death occurred to make changes. Marriage/Dissolution(Divorce)Certificates: 1. Personal fact(s) (minor spelling changes in name,date or place of birth or residence)may be changed by affidavit(with proof) by the person. 2. To change the date or place of marriage or dissolution,the officiant(marriage)or clerk of court(dissolution)must sign the affidavit. DOH/OHS 023(Rev.912002) CERTIFIED JEFFERSONc PIL OCT 21 2009 i Thunms Locke,M.D. " Health Offs RR00540571 Fl .m. E 09 OCT 22 PH i?: O LAST WILL AND TESTAMENT RUTH JUFHI 0 s00 cl MY OF ELIZABETH B. GIBLER I9 4 00110 0 I, ELIZABETH B. GIBLER aka ELIZABETH B. STALEY, a resident of Jefferson County, Washington, declare this to be my Will and revoke all prior Wilts and Codicils. ARTICLE 1. FAMILY I am a single woman residing in Port Townsend, Washington. My immediate family now consists of my three adult children: JOHN DANIEL STALEY, MICHAEL EDWARD STALEY, and ELIZABETH MARGARET STALEY KELLEHER. Except as provided below, I make no provision in this Will for any child who survives me, nor for the descendants of any child who does not survive me. ARTICLE 2. PERSONAL REPRESENTATIVE 2.1 Designation. I appoint EDWARD MARSHALL MILBOURN as my Personal Representative("Personal Representative"). If EDWARD MARSHALL MILBOURN at any time declines, fails, or is unable to act as my Personal Representative, I appoint DAVID G. GOODING as Personal Representative. 2.2 Bond, Waiver; Powers. No bond, surety, or other security shall be required of my Personal Representative in any jurisdiction for any purpose. My Personal Representative shall have nonintervention powers to settle my estate in the manner set forth in this Will. Furthermore, my Personal Representative shall have full power, authority, and discretion to do all that my Personal Representative thinks necessary or desirable in administering my estate. LAST WILL &TESTAMENT OF ELIZABETH B. GIBLER I t(1� Page 1 of 4 , r T- 2.3 Ancillary Administration. My Personal Representative may appoint an Ancillary Personal Representative to act in any state where ancillary administration is necessary and where my Personal Representative for any reason fails to qualify or declines to serve. Any Ancillary Personal Representative shall have, with respect to property subject to ancillary administration, all the powers conferred upon my Personal Representative. 2.4 Washington Uniform Transfers to Minors Act. If any property passes hereunder to a beneficiary who is then under the age of twenty-one (21), such property shall be given to an individual or entity selected by my Personal Representative as custodian under the Washington Uniform Transfers to Minors Act. Such property shall be used and managed for the benefit of the beneficiary who otherwise would have received the same until he or she attains the age of twenty-one (21), at which time it shall be distributed to him or her outright. ARTICLE 3. DISPOSITION OF PROPERTY 3.1 List Bequest. I give such of my tangible personal property and/or jewelry to those persons designated in a separate writing in my handwriting or signed by me and which describes the items therein with reasonable certainty which may be amended from time to time. Said list is to be deemed a part of this Will. 3.2 Specific Bequest. 3.2.1 I give the following real property to Elizabeth Margaret Staley Kelleher: Parcel A: The south 110 feet of the North 770 feet of Government Lot 1, Section 5, Township 29 North, Range 1 West, W;M., TOGETHER WITH the East 400 feet of the South 100 feet of the North 660 feet of said Government Lot 1 AND TOGETHER WITH all tidelands of the second class, as conveyed by the State of Washington, situate in front of, adjacent to, or abutting thereon. Situate in Jefferson County, Washington. LAST WILL &TESTAMENT OF ELIZABETH B. GIBLER Page 2 of 4 6 3.2.2 I give the following real property to Michael Edward Staley: Parcel B: That portion of the South 110 feet of the North 880 feet of Government Lot 1, Section 5, Township 29 North, Range 1 West, W.M. lying westerly of State Highway 20. TOGETHER WITH all tidelands of the second class, as conveyed by the State of Washington, situate in front of, adjacent to, or abutting thereon. Situate in Jefferson County, Washington. 3.2.3 I give the following real property to John Daniel Staley: Parcel C: That portion of the South 110 feet of the North 990 feet of Government Lot 1, Section 5, Township 29 North, Range 1 West, W.M., lying westerly of State Highway 20. TOGETHER WITH all tidelands of the second class, as conveyed by the State of Washington, situate in front of, adjacent to, or abutting thereon. Situate in Jefferson County, Washington. 3.3 Expenses; Gifts to Minors. Any expenses incurred in safeguarding or delivering any tangible personal property shall be paid from my estate as an administration expense. My Personal Representative shall be discharged in distributing tangible personal property given to any minor child when the child or any adult having the custody of the child delivers a written receipt to my Personal Representative. 3.4 Definition of Residue. The "residue of my estate" means all probate estate property which I own at the time of my death and which remains after gifts made in Articles 3.1 and 3.2, and after payment of claims, expenses, taxes and other liabilities of my estate. 3.5 Disposition of Residue. 3.5.1 I give all of the residue of my estate to my children, JOHN DANIEL STALEY, MICHAEL EDWARD STALEY and ELIZABETH MARGARET STALEY KELLEHER, share and share alike. If any of my children fails to survive me, then his or her share shall be distributed to his or her issue by right of representation. LAST WILL & TESTAMENT OF ELIZABETH B. GIBLER Page 3 of 4 ARTICLE 4. NON-PROBATE PROPERTY I understand that this Will does not dispose of property held in joint tenancy or in trust,.life insurance, employee benefits, including retirement and IRAs, or other types of property where a specific beneficiary other than my estate has been designated. ARTICLE 5. MISCELLANEOUS This instrument shall be governed by the laws of the state of Washington. Any provision prohibited by law or unenforceable shall not affect the remaining provisions of this instrument. References to or use of the masculine include the feminine and vice versa and the singular includes the plural unless the context otherwise requires or indicates. DATED this ' day of Ifl €414 't--' , 2004. • , , r 6, iiii,644't-- ELIZAB- B. GIBLER aka ELI • :ETH B. STALEY Testator This instrument, consisting of four (4) pages, of which this is the last, was on the g4-41 day of b ctotof , 2004, signed, sealed, and published by Elizabeth B. Gibler aka Elizabeth B. Staley, as and declared to be her Last Will and Testament in the presence of each of us who, at her request and in her presence and in the presence of each other, have subscribed our names as witnesses thereto. `. l (-) residing at Port Townsend, Washington. RICHARD L. SHAPIEYFELT A) I kkasaiding at Port Townsend, Washington. VANESSA RIDGW 411) LAST WILL&TESTAMENT OF ELIZABETH B. GIBLER Page 4of 4 "iS4 CERTIFICATE The undersigned, Richard L. Shaneyfelt and Vanessa Ridgway are the witnesses to the Last Will and Testament of Elizabeth B. Gibler; the Testator declared to each of the undersigned in their presence and on the date stated therein that said instrument was her Last Will and Testament, that she executed it for such purpose, and requested that each of the undersigned sign said Will as attesting witnesses; the undersigned did so in the presence of the Testator; the Testator was then over eighteen years of age and of sound mind and acted freely without duress or undue influence; each of the undersigned witnesses was then over eighteen years of age and otherwise competent to be an attesting witness; and this certification is made at the request of the Testator for the purpose of being presented to a court of competent jurisdiction to prove the foregoing Last Will and Testament. The undersigned certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. --i Kry j/r ! ` I Witness l Pr-----1:-„i,„,„, ,_1 i DATED: 0,7, 87 , 2004, at 1"1`"'�>„v,-.�,<_,-y{ , Washington. ,_ .4 .A i. 'V`l11.::.ie\ilia/ fitness IP DATED: Re_,C6iNt, S , 2004, at a f 1 Alik%:,!i , Washington. LAST WILL &TESTAMENT OF ELIZABETH B. GIBLER • 1 FI .-. ED 2 00 OCT 22 PH 2: 03 3 JEFFERSON COUNTY 4 RUTH GORDON. CLERK 5 6 7 IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON 8 IN AND FOR THE COUNTY OF JEFFERSON 9 In the Matter of the Estate of ) NO. a 9 4 00 1 1 0 0 10 ELIZABETH B. GIBLER, ) LETTERS 11 ) TESTAMENTARY Deceased. ) 12 ) 13 STATE OF WASHINGTON ) )ss. 14 COUNTY OF JEFFERSON ) 15 WHEREAS,the Last ill and Testament of ELIZABETH B. GIBLER, deceased was on they of 16 October,2009, duly exhibited, 'roved and recorded in our said Superior Court; 17 AND WHEREAS, it ap'ears in and by said Will that EDWARD M. MILBOURN is hereby appointed as 18 personal representative therein .nd said EDWARD M. MILBOURN has duly qualified. 19 NOW, THEREFORE, know all persons by these presents,that I do hereby authorize said EDWARD M. 20 MILBOURN to execute said Wi 1 according to law. 21 WITNESS my hand and seal of this Court affixed this day of October, 2009. 22 RUTH GORDON, 23 Clerk of -curt • 1 , 24 gy,- 411'`►�r. ,�.. 25 - Deputy Ili° 26 27 28 RICHARD L.SHANEYFELT ATTORNEY AT LAW LETTERS TESTAMENTARY 1101 CHERRY STREET Page / of! PORT TOWNSEND,WA 98368 (360)385-0120 1 F ! ._.. E D 2 09 OCT 22 PH 2: 02 3 JEFFERSON COUNTY RUTH GORDON, CLERK 4 5 6 7 IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON 8 IN AND FOR THE COUNTY OF JEFFERSON 9 In the Matter of the Estate of ) NO. 0 9 4 0 0 1 1 0 0 10 ELIZABETH B. GIBLER, ) ORDER ADMITTING WILL TO ) PROBATE AND ESTABLISHING 11 Deceased. ) SOLVENCY 12 13 The Petition for Probate of Will and for Order of Solvency of the above-named decedent has been 14 presented on behalf of EDWARD M. MILBOURN, Petitioner, now, therefore, the Court finds: 15 1. ELIZABETH B. GIBLER died on October 19,2009, in Jefferson County, Washington, was a 16 resident of Jefferson County, Washington, and left real and personal property in Jefferson County subject to 17 probate. 18 2. Decedent executed a Will on December 8, 2004, in the presence of competent witnesses, and 19 the Petitioner, EDWARD M. MILBOURN, has been named therein as personal representative, without bond 20 and with nonintervention powers. 21 3. The known assets of the estate are valued in excess of the known debts. Petitioner believes the 22 estate to be solvent. 23 4. The decedent was a single woman. The following are her heirs at law: 24 • ELIZABETH M. KELLEHER Daughter Adult 25 • MICHAEL E. STALEY Son Adult 26 • JOHN D. STALEY Son Adult 27 28 RICHARD L.SHANEYFELT ATTORNEY AT LAW ORDER ADMITTING WILL TO PROBATE AND ESTABLISHING SOLVENCY 1101 CHERRY STREET PORT TOWNSEND,WA 98368 Page I of 2 (360)385-0120 1 5. Petitioner requests the appointment of Richard L. Shaneyfelt, Attorney at Law, 1 101 Cherry 2 Street, Port Townsend, WA 98368 as Resident Agent for this estate since Petitioner resides outside of the state 3 of Washington. Richard L. Shaneyfelt is the attorney for this estate and has agreed to serve as its resident agent. 4 From the foregoing Findings of Fact the Court makes the following: 5 ORDER 6 1. That the offered Will is established as the Last Will of the decedent and admitted to probate; 7 2. That EDWARD M. MILBOURN is appointed as Personal Representative to act without bond 8 upon the filing of the Oath of Personal Representative. 9 3. That EDWARD M. MILBOURN is authorized to serve/administer and close this estate without 10 further Court intervention or supervision as provided by RCW Chapter 11.68. 11 4. Richard L. Shaneyfelt,Attorney at Law, is appointed the resident agent for the estate. 12 13 DATED this /drday of October, 2009. 14 CRADDOCK D.VERSER 15 JUDGE JUDGE/COMMISSIONER 16 Presented by: 17 18 VA I 19 RICHARD L. SHANE FELT, WSBA#2969 Attorney for Persona epresentative 20 21 22 23 24 25 26 27 28 RICHARD L.SHANEYFELT ATTORNEY AT LAW ORDER ADMITTING WILL TO PROBATE AND ESTABLISHING SOLVENCY1101 CHERRY STREET PORT TOWNSEND,WA 98368 Page 2 of 2 (360)385-0120 PP Fr yOCT 22 Pil I?: r 1 JEFFERSON C' ;T1' LAST WILL AND TESTAMENT RUTH -Q'R[;I^ OF ELIZABETH B. GIBLER � 9 4 00110 0 I, ELIZABETH B. GIBLER aka ELIZABETH B. STALEY, a resident of Jefferson County, Washington, declare this to be my Will and revoke all prior Wills and Codicils. ARTICLE 1. FAMILY I am a single woman residing in Port Townsend, Washington. My immediate family now consists of my three adult children: JOHN DANIEL STALEY, MICHAEL EDWARD STALEY,and ELIZABETH MARGARET STALEY KELLEHER. Except as provided below, I make no provision in this Will for any child who survives me, nor for the descendants of any child who does not survive me. ARTICLE 2. PERSONAL REPRESENTATIVE 2.1 Designation. I appoint EDWARD MARSHALL MILBOURN as my Personal Representative ("Personal Representative"). If EDWARD MARSHALL MILBOURN at any time declines, fails, or is unable to act as my Personal Representative, I appoint DAVID G. GOODING as Personal Representative. 2.2 Bond, Waiver; Powers. No bond, surety, or other security shall be required of my Personal Representative in any jurisdiction for any purpose. My Personal Representative shall have nonintervention powers to settle my estate in the manner set forth in this Will. Furthermore, my Personal Representative shall have full power, authority, and discretion to do all that my Personal Representative thinks necessary or desirable in administering my estate. LAST WILL &TESTAMENT II OF ELIZABETH B. GIBLER Page 1of 4 ` ! Oh /3 C )31 I 2.3 Ancillary Administration. My Personal Representative may appoint an Ancillary Personal Representative to act in any state where ancillary administration is necessary and where my Personal Representative for any reason fails to qualify or declines to serve. Any Ancillary Personal Representative shall have, with respect to property subject to ancillary administration, all the powers conferred upon my Personal Representative. 2.4 Washington Uniform Transfers to Minors Act. If any property passes hereunder to a beneficiary who is then under the age of twenty-one (21), such property shall be given to an individual or entity selected by my Personal Representative as custodian under the Washington Uniform Transfers to Minors Act. Such property shall be used and managed for the benefit of the beneficiary who otherwise would have received the same until he or she attains the age of twenty-one (21), at which time it shall be distributed to him or her outright. ARTICLE 3. DISPOSITION OF PROPERTY 3.1 List Bequest. I give such of my tangible personal property and/or jewelry to those persons designated in a separate writing in my handwriting or signed by me and which describes the items therein with reasonable certainty which may be amended from time to time. Said list is to be deemed a part of this Will. 3.2 Specific Bequest. 3.2.1 I give the following real property to Elizabeth Margaret Staley Kelleher: Parcel A: The south 110 feet of the North 770 feet of Government Lot 1, Section 5, Township 29 North, Range 1 West, W.M., TOGETHER WITH the East 400 feet of the South 100 feet of the Nbrth 660 feet of said Government Lot 1 AND TOGETHER WITH all tidelands of the second class, as conveyed by the State of Washington, situate in front of, adjacent to, or abutting thereon. Situate in Jefferson County, Washington. LAST WILL &TESTAMENT OF ELIZABETH B. GIBLER Page 2 of 4 itg4. I , , a rC�Department of evenue REAL ESTATE EXCISE TAX AFFIDAVIT wasnmgron scareThis form is your receipt PLEASE TYPE OR PRINT CHAPTER 82.45 RCW-CHAPTER 458-61A WAC when stamped by cashier. THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED (See back of last page for instructions) 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name. Name Edward M. Milbourn, Personal Rep. of • Name Elizabeth Margaret Staiey Ke?.xeiicr the Estate of Elizabeth B. Gibler go x w p 5Mailing Address 5251 S 200 E Mailing Address 730 4C3elma Beach Road r city/state/zip Greenfield, IN 46.140 ca City/State/Zip Port Townsend, WA 98368 Phone No.(including area code) Phone No.(including area code) List all real and personal property tax parcel account © Send all property tax correspondence to:[g Same as Buye/Grantee personalP P rtY List assessed value(s) numbers—check box if prope Name 901-042-006 6 T�1i ( ❑ • Mailing Address 901-051-003 -ANc..c.,CE L(L. . 61.r Ci 50 i i t pil City/State/Zip 901-051-0233-m 51) f2k'-I(o ❑ i''~ Phone No.(including area code) 4 T.L. TA)4. E ❑ © Street address of property: This property is located in❑unincorporated Jefferson County OR within❑city of Check box if any of the listed parcels are being segregated from a larger parcel. Legal description of property(if more space is needed,you may attach a separate sheet to each page of the affidavit) SEE EXHIBIT A ®Enter Abstract Use Categories: ® List all personal property(tangible and intangible)included in selling price. (See back of last page for instructions) YES NO If claiming an exemption,list WAC number and reason for exemption: Is this property exempt from property tax per chapter ❑ CX". 84.36 RCW(nonprofit organization)? WAC No. (Section/Subsection) 458-61A-202 © YES NO inheritance Reason for exemption Is this property designated as forest land per chapter 84.33 RCW? ❑ [k Is this property classified as current use(open space,faun and 0 Ek agricultural,or timber)land per chapter 84.34? Is this property receiving spa.ial valuation as historical property 0 Ei( Type of Document Qi r i r 1 a im Dppsi per chapter 84.26 RCW? �Q !WI t's If any answers are yes,complete as instructed below. Date of Document f (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) Gross Selling Price $ NEW OWNER(S):To continue the current designation as forest land or *personal Property(deduct) $ classification as current use(open space,farm and agriculture,or timber) land,you must sign on(3)below.The county assessor must then determine Exemption Claimed(deduct) $ if the land transferred continues to qualify and will indicate by signing below. Taxable Selling Price $ If the land no longer qualifies or you do not wish to continue the designation Excise Tax: State $ or classification,it will be removed and the compensating or additional taxes will be due and payable by the seller or transferor at the time of sale.(RCW Local $ 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact *Delinquent Interest: State $ your local county assessor for more information. Local $ This land ❑does ❑does not qualify for continuarce. *Delinquent Penalty $ Subtotal $ DEPUTY ASSESSOR DATE (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY); *State Technology Fee $ 5.00 NEW OWNER(S):To continue special valuation as historic property, *Affidavit Processing Fee $ sign(3)below.If the new owner(s)do not wish to cont nue,all Total Due $ 0•00 additional tax calculated pursuant to chapter 84.26 RCW,shall be due and payable by the seller or transferor at the time of sale. (3) OWNER(S)SIGNATURE A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS PRINT NAME I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of Signature of Grantor or Grantor's Agent Grantee or Grantee's Agent Name(print) Fr---„,, , . Name(print)"i.?"1a eth , g r..-e r. Date&city of signing: Date&city of signing: Aril •,. ;_. Perjury:Perjury is a class C felony which is punishable by imprisonment in the state correctional institution fora maximum term of not more than five years,or by a fine in an amount fixed by the court of not more than five thousand dollars($5,000.00),or by both imprisonment and fine(RCW 9A.20.020(1C)). REV 84 0001a(06/02/06) THIS SPACE TREASURER'S USE ONLY COUNTY ASSESSOR • 1 46 84 CDepartment of evenue REAL ESTATE EXCISE TAX AFFIDAVIT Washing=State This form is your receipt PLEASE TYPE OR PRINT CHAPTER 82.45 RCW- HAPTER 458-61A WAC when stamped by cashier. THIS AFFIDAVIT WILL NOT BE ACCEPTED ALL AREAS ON ALL PAGES ARE FLrLLY COAIPLETED (See back of last page for instructions) ❑Check box if partial sale of property If multiple owner l p rcentage of ownership next to name. 0 Name Edward M. Milbourn, Personal Rep. of ® Name Michael Staley the Estate at Elizabeth B. Gibler w° 5251 S 200E x w z Mailing Address w�, Mailing Address 8073 Elnora Court 4Z1 City/State/Zip Greenfield, IN 46140 m City/State/Zip fir-rArpntrs CA 95cI74 Phone No.(including area code) Phone No.(including area code) List all real and personal property tax pardel account © Send all property tax correspondence to:RI Same as Buyer'Grantee numbers—check box if personal property List assessed value(s) Name 901-042-006 ❑ 5 Mailing Address 901--051-003 ❑ ()VPi 7`y City/State/Zip 901-051-023 ❑ Phone No.(including area code) ❑ riStreet address of property: This property is located in❑unincorporated_Jefferson County OR within❑city of Check box if any of the listed parcels are being segregated from a larger parcel. Legal description of property(if more space is needed you may attach a separate sheet to each page of the affidavit) SEE EXHIBIT A ®Enter Abstract Use Categories: ® List all personal property(tangible and intangible)included in selling price. (See back of last page for instructions) YES NO If claiming an exemption, list WAC number and reason for exemption: Is this property exempt from property tax per chapter ❑ EJ 84.36 RCW(nonprofit organization)? WAC No. (Section/Subsection) 458-61A-202 YES NO Inheritance Reason for exemption Is this property designated as forest land per chapter 84.33 RCW? 0 I Is this property classified as current use(open space,farm and 0 agricultural,or timber)land per chapter 84.34? Is this pm yre*eiving special valualionashistorical property 0 IR Type of Document Quit Claim Deed per chapter 84.26 RCW? } If any answers are yes,complete as instructed below. Date of Document (} (1)NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE) Gross Selling Price $ NEW OWNER(S):To continue the current designation as forest land or *personal Property(deduct) $ classification as current use(open space,farm and agriculture,or timber) land,you must sign on(3)below.The county assessor must then determine Exemption Claimed(deduct) $ if the land transferred continues to qualify and will indicate by signing below. Taxable Selling Price $ If the land no longer qualifies or you do not wish to continue the designation Excise Tax: Stte $ or classification,it will be removed and the compensating or additional taxes will be due and payable by the seller or transferor at the time of sale.(RCW Lodal $ 84.33.140 or RCW 84.34.108).Prior to signing(3)below, 'ou may contact *Delinquent Interest: Stt to $ your local county assessor for more information. Lodal $ This land ❑does ❑does not qualify for continuance. *Delinquent Penalty $ Subtotal $ DEPUTY ASSESSOR DATE *State Technology Fee $ 5.00 (2)NOTICE OF COMPLIANCE(HISTORIC PRQPER' )'Affidavit Processing NEW OWNER(S):To continue special valuation as his*ric pro g F . $ sign(3)below.If the new owner(s)do not wish to continue,all Total Due $ CIU additional tax calculated pursuant to chapter 84.26 RCW,shall be due and payable by the seller or transferor at the time of sale. (3) OWNER(S)SIGNATURE A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS PRINT NAME ® I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of a/jT;f Signature of Grantor or Grantor's Agent_ �`� Grantee or Grantee's Agent ? Name(print) FJ. „ 1bourn, PR Name(print) Michael S`.ii.ey Date&city of signing: _ J' r t' Date&city of signing: ,4'f)/. ,'" IlGfl>t � 71Z'74-11." Perjury:Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum term of not more than five years,or by a fine in an amount fixed by the court of not more than five thousand dollars($5,000.00),or by both imprisonment and fine(RCW 9A.20.020(1C)). REV 84 000a$ tik/82/o6) TI$'IS SPACE,.TREASURER'S USE ONLY COUNTY ASSESSOR �' I ' 2., 1'6-% 1 1 4 6 8 5 V rip Department of k C. evenue washxngron store REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61A WAC when stamped by cashier. THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED (See back of last page for instructions) D Check box if partial sale of property If multiple owners,_40�t percentage of ownership next to name. d M. Milbourn, Personal Re of .~% Name cr rwarP- the� Name John D. Staley x Estate of Elizabeth B. Gibler a o Mailing Address 52551 S 200 E z Mailing Address 4062 Clear Court o City/State/Zip Greenfield; IN 46140 w g City/State/Zip Placerville, CA 95667 Phone No.(including area code) Phone No.(including area code) ® Send all property tax correspondence to:®Same as Buyer/Grantee List all real and personal property tax parcel account List assessed value(s) numbers—check box if personal property Name 901-042-076 ❑ Mailing Address 901-051-003 ❑ 619') City/State/zip 901-051-023El Phone No.(including area code) 0 IIStreet address of property: This property is located in 0 unincorporated Jefferson County OR within 0 city of Check box if any of the listed parcels are being segregated from a larger parcel. Legal description of property(if more space is needed,you may attach a separate sheet to each page of the affidavit) SEE EXHIBIT A ®Enter Abstract Use Categories: lirl List all personal property(tangible and intangible)included in selling price. (See back of last page for instructions) YES NO If claiming an exemption,list WAC number and reason for exemption: Is this property exempt from property tax per chapter ❑ 84.36 RCW(nonprofit organization)? WAC No.(Section/Subsection 45R-61 A-702 ® YES NO Is this designatedas forest land chapter 84.33 RCW? Reason for exemption Inheritance property per hap t Is this property classified as cunvnt use(open space,fart and ❑ Q agricultural,or timber)land per chapter 84.34? Is this property receiving special valuation as historical ProPertY ❑ lil Type of Document • 't Cl;.im Deed per chapter 84.26 RCW? rr�t `f 10 If any answers are yes,complete as instructed below. Date of Document i (1)NOTICE OF CONTINUANCE(FOREST LAND OR CUR RENT USE) Gross Selling Price $ NEW OWNER(S):To continue the current designation as forest land or *personal Property(deduct) $ classification as current use(open space,farm and agriculture,or timber) land,you must sign on(3)below.The county assessor must then determine Exemption Claimed(deduct) $ if the land transferred continues to qualify and will indicate by signing below. Taxable Selling Price $ If the land no longer qualifies or you do not wish to contint e the designation Excise Tax: State $ or classification,it will be removed and the compensating or additional taxes will be due and payable by the seller or transferor at the thr a of sale.(RCW Local $ 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact *Delinquent Interest: State $ your local county assessor for more information. Local $ This land ❑does ❑does not qualify for continuance. *Delinquent Penalty $ _ DEPUTY ASSESSOR DATE. Subtotal $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPER *State Technology Fee $ 5.00 -; NEW OWNER(S):;To continue special valuation as hitioric prdpe ty, ' , s *Affidavit Processing Fee $ sign(3)below.If the new owner(s)do not wish to continue,all Total Due $ additional tax calculated pursuant to chapter 84.26 RCW,shall be due l0,on and payable by the seller or transferor at the time of salt. (3) OWNER(S)SIGNATURE A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS PRINT NAME ® I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. . Signature of .,,' .7.�'' Signature of /y )s Grantor or Grantor's Agent,'-"F/ -%` c >✓^`s= Grantee's ! i� //� Grantee or Agent -: ✓ � Name(print) E iva3'ci M Mi I bourn, Pi" Name(print) John D. Staley Date&city of sighing: /C/' ,/- Date&city of signing: ,04*'T . 4,J,0 9-:::00.0 '7/x.7! LI Perjury:Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for aMaximum term of not more than five years,or by a fine in an amount fixed by the court of not more than five thousand dollars($5,000.00),or by both imprisonment and fine(RCW 9A.20.020(IC)). REV 84 000,18(Q6102/06) THIS SPACE-TRASURER'S,,piSt ONLY COUNTY ASSESSOR r` 1i k.�s 1 146 86 Page 1 of 2 Michelle Farfan • From: Jodi Cossell Sent: Monday,October 04,2010 10:30 AM To: Michelle Farfan Cc: Sherrie Shold Subject: RE:APN 901-051-023 Hi Michelle, This was a Senior Citizen Exemption parcel only. When Ms.Gibler passed away we consolidated the parcel back to its original number(901051003)and deleted this parcel number as it no longer qualified for the exemption program. This was only considered 2 separate parcel numbers because of the exemption program and taxing purposes. You will not find the Senior exemption parcel number on the map because it is for tax purposes only. Thanks, Jodi From: Michelle Farfan Sent: Monday,October 04, 2010 10:15 AM To:Sherrie Shold;Jodi Cossell Subject:APN 901-051-023 Hi: I'm trying to locate this parcel on the quarter section maps. The descriptions below seems to fit under APN 901-051-003 with the exception of TL Tax E-S/C ex ptn. I have a last will and testamentary division I'm working on sending over. Any help or explanation is appreciated. Thanks. Screen: 01 REAL PROPERTY MASTER Mode: INQUIRY Auto Roll:OFF Parcel#000901051023 Geo Cd 290105105110 S5 T29 R1W Nbhd Cd 5375 TAX 6(ENLG BY TX 31),TAX RR-16 TL TAX E-S/C EX PTN Loc ID * Taxpayer Cd GIBL 1000 GIBLER,ELIZABETH B T/P Chg Dt 4/26/1999 *Title Owner T/P Chg Usr SS Tax Code 0111 Status DL DELETED Land Use 1100 RES-SINGLE Affidavit Vol/Page / C/U Code Legal Doc BLA#73694&73697 Amount User Cd Acres F/M Value C/U Value S/C Value Improved Land Appraisal Yr 2010 Unimprov Land New Con Bld Timberland New Con Lnd Improvements Mobile Home Totals Chg Date 10/21/2009 Fire Patrol N Regular Taxable Value Chg User JODI RESIDUAL ACREAGE#901051003 F5=Appraisal F6=Windows F7=End of Job F9=Situs Address F13=History 10/4/2010 Page 2 of 2 Michelle Farfan Associate Planner,FHM Lead Dept of Community Development 622 Sheridan port Townsend WA 98368 mfarfan@cojefferson.wa.us 360-379-9957 360.3791',73(fax) All voice messages and e-mails received by Jefferson CountY maY be subject to Public Disclosure under Chapter 92.56 Please note that DCD hours changed as of December i,2008. Our office Is open to the public 9:00 am-9:30 pm Monday to Thursday and closed on fridaYs. 10/4/2010 Page 1 of 2 Michelle Farfan From: Michelle Farfan Sent: Monday, December 13, 2010 4:22 PM To: 'maggie KELLEHER' Subject: FW: MLA10-00344, Last Will & Testamentary Division Hi Maggie: Here's an email that was sent to Mike by Stacie Hoskins, Planning Manager while I was out sick. I have not received the Assessor's comments yet, but do expect them tomorrow. Once received, I'll be able to proceed with the application. Regards, Michelle Farfan Associate Planner,FHM Lead Dept. of Community Development 622 Sheridan port Townsend WA 98368 mfarfan@coJefferson.wa.us 360-379-4457 360-379-4473 (fa)) All voice messages and e-mails received by Jefferson County maY be subject to Public Disclosure under Chapter 42.5612CW. Please note that DCD hours Changed as of December i, 2.008. Our office is open to the public 9:00 am -4:30 pm Monday to ThursdaY and closed on Fridays. From: Stacie Hoskins Sent: Friday, December 10, 2010 3:29 PM To: 'Mike Staley' Cc: Michelle Farfan; Sherrie Shold Subject: RE: MLA10-00344, Last Will &Testamentary Division Hello, Mike, Thank you for calling regarding your application. I pulled the case file and spoke with Sherrie Shold of the Assessor's Office. The Assessor's comments are complete and will be sent to our office Monday. At that time, Michelle Farfan or I will be able to provide you with more information and/or issue an approval. Have a good weekend! Stacie Stacie 4, qadear2 Planning Manager Jefferson County Department of Community Development 621 Sheridan Street 12/13/2010 Page 2 of 2 Port Townsend, WA 98368 Phone 360-379-4463 Fax 360-379-4451 shoskinsPco.jefferson.wa.us All e-mail sent to this address will be received by the Jefferson County e-mail system and may be subject to Public Disclosure under Chapter 42.58 RCW SAVE PAPER - Please do not print this a-mail unless absolutely necessary From: Mike Staley [mailto:Mike.Staley@californiavolunteers.ca.gov] Sent: Thursday, December 09, 2010 11:38 AM To: Stacie Hoskins Cc: 'mike_staley@comcast.net' Subject: Thank you I appreciate your time talking to me. I know how busy we can get. Michael Staley Assistant Director Disaster Volunteering and Preparednes- Department California Volunteers 1110 K Street Sacramento, CA 95814 mike.stale • califomiavolunteers.ca..ov Desk: 916.445.6687, BB: 916.204.9802, Fax 916.323.3227 12/13/2010 Page 1of1 Stacie Hoskins From: Stacie Hoskins Sent: Friday, December 10, 2010 3:29 PM To: 'Mike Staley' Cc: Michelle Farfan; Sherrie Shold Subject: RE: MLA10-00344, Last Will &Testamentary Division Hello, Mike, Thank you for calling regarding your application. I pulled the case file and spoke with Sherrie Shold of the Assessor's Office. The Assessor's comments are complete and will be sent to our office Monday. At that time, Michelle Farfan or I will be able to provide you with more information and/or issue an approval. Have a good weekend! Stacie St4ue Z. Wod ei4a Planning Manager Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 Phone 360-379-4463 Fax 360-379-4451 shoskins@co.jefferson.wa.us All e-mail sent to this address will be received by the Jefferson County e-mail system and may be subject to Public Disclosure under Chapter 42.56 RCW SAVE PAPER - Please do not print this e-mail unless absolutely necessary From: Mike Staley [mailto:Mike.Staley@californiavolunteers.ca.gov] Sent: Thursday, December 09, 2010 11:38 AM To: Stacie Hoskins Cc: 'mike_staley@comcast.net Subject: Thank you I appreciate your time talking to me. I know how busy we can get. Michael Staley Assistant Director Disaster Volunteering and Preparedness Department California Volunteers 1110 K Street Sacramento, CA 95814 mike.staley(a)californiavolunteers.ca.gov Desk: 916.445.6687, BB: 916.204.9802, Fax 916.323.3227 12/10/2010 1 Page 1 of 2 Michelle Farfan AL4ti _.5�1L ,5U810- From: Sherrie Shold Sent: Monday,October 11,2010 8:40 AM To: Michelle Farfan Subject: RE:APN 901-051-023 Michelle, I know Jodi answered this question. However, I have a couple of affidavits on my desk where they are trying to divide the property I just hadn't had a chance to send them over with a map showing how they want it divided,but I will today. Sorry, I was waiting to do a cover letter. sherrit Sherrie Shold Property Operations Jefferson County Assessor's Office 360-385-9105 sshold@cojefferson.wa.us From: Michelle Farfan Sent: Monday,October 04, 2010 10:15 A To:Sherrie Shold;Jodi Cossell Subject:APN 901-051-023 Hi: I'm trying to locate this parcel on the q arter section maps. The descriptions below seems to fit under APN 901-051-003 with the xception of TL Tax E-S/C ex ptn. I have a last will and testamentary division I'm wor ing on sending over. Any help or explanation is appreciated. Thanks. Screen: 01 REAL PROPER Y MASTER Mode:INQUIRY uto Roll: OFF Parcel#000901051023 Geo Cd 290 05105110 S5 T29 RI W Nbhd Cd 5375 TAX 6(ENLG BY TX :1),TAX RR-16 TL TAX E-S/C EX P Loc ID *Taxpayer Cd GIBL 1000 GIBLER,ELIZABETH B T/P Chg Dt 4/26/1999 *Title Owner T/P Chg Usr SS Tax Code 0111 Status DL DELE ED Land Use 1100 RES-SINGLE Affidavit Vol/Page / C Code Legal Doc BLA#73694&73697 Amount User Cd Acres F/M Value C/U Valu• S/C Value Improved Land Appraisal Yr 2010 Unimprov Land New Con Bid Timberland New Con Lnd Improvements Mobile Home Totals Shg Date 10/21/2009 Fire Patrol N Regular Taxable Va ue Chg User JODI 10/12/2010 Page 2 of 2 RESIDUAL ACREAGE#901051003 F5=Appraisal F6=Windows F7=End of Job F9=Situs Address F13=History Michelle FarFan Associate Planner,FHM Lead Dept.of Community Development 621 gherldan port Townsend WA 98368 mfarfan®co jefferson.wa.us 360-379-4457 360.379.9473(Fax) All voice messages and e-mails received by Jefferson County maY be subject to Public Disclosure under Chapter 42.56 RCW. Please note that DCD hours changed as Of December i,2008. Our office Is open to the public 9:00 am-4:30 pm Monday to Thursday and closed on Fridays. 10/12/2010 • gsoN JEFFERSON COUNTY waw 6: DEPARTMENT OF COMMUNITY DEVELOPMENT • 1-4 621 Sheridan Street 16 0) Port Townsend, WA 98368 Octoberf 2010 (p� Al Scalf, Director Dear Re ' wer, })c-a— h RE: MLA10-00344 Jefferson County has forwarded the attached application to you for review and comment because your agency is responsible for determining compliance with state and federal requirements or may otherwise be affected by the following proposal: LAST WILL & TESTAMENTARY DIVISION Location: Parcel number 901 051 003 & 901 042 006, Section 5, Township 29, Range 1W, WM, located at 730 Adelma Beach Road, Port Townsend 98368 ZS� Comments must be received within fourteen (14)calendar days or by October,23,2010. lino written response has been received within fourteen (14)days,your agency will be presumed to have no comments. If necessary,the UDC administrator may grant an extension of time for comment. Please contact at (360)379.4450 if you desire an extension of time or have additional questions regarding this proposal. Thank you in advance for your attention to this matter. Sincerely, 4frAtsh. C: Building Permits/ Inspections Development Review Division Long Range Planning (360) 379-4450 FAX: (360) 379-441 gs N JEFFERSON COUNTY wowoko °G� DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street N% 0$ Port Townsend, WA 98368 -- tr October 2010 Al Scalf, Director Dear Rer, �kJ RE: MLA10-00344 Jefferson County has forwarded the attached application to you for review and comment because your agency is responsible for determining compliance with state and federal requirements or may otherwise be affected by the following proposal: LAST WILL & TESTAMENTARY DIVISION Location: Parcel number 901 051 003 & 901 042 006, Section 5, Township 29, Range 1W, WM, located at 730 Adelma Beach Road, Port Townsend 98368 Comments must be received within fourteen (14)calendar days or by October$2 010. If no written response has been received within fourteen (14) days,your agency will be presumed to have no comments. If necessary,the UDC administrator may grant an extension of time for comment. Please contact at (360)379-4450 if you desire an extension of time or have additional questions regarding this proposal. Thank you in advance for your attention to this matter. Sincerely, /ivQ c: , Building Permits/ Inspections Development Review Division Long Range Planning (360) 379-4450 FAX: (360) 379-4451 ti C oN i JEFFERSON COUNTY ' DEPARTMENT OF COMMUNITY DEVELOPMENT kil ` iy 621 Sheridan Street• Port Townsend • Washington 98368 4$ 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment l'SINS (, Master Permit Application MLA: 1 0 .344 3 4`� Project Description(include separate sheets as necessary): L•Is U) I TesfamPAtrb( Tax Parcel Number: .901-042-006, 901-051-0W, Property Size: (acres/square feet) Site Address and/or Directi2N-fOc135asFSW. Property Owner(s)of Record: Elizabeth B. Gibler, deceased Telephone: Fax: email: Mailing Address: I Applicant/Agent(if different from owner): Edward M. Milbourn, Personal Reprsentative, Estate of Telephone: Fax: email: Elizabeth B. Gibler Mailing Address: 5251 S 200 E, Greenfield, IN 46140 What kind of Permit?(Check each box that applies ❑Lot or Road Segregation ['Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit Cl Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑ Garage Attached/Detached ❑Conditional Use[C(a), C(d),or C)** ❑ Manufactured Home 0 Modular r - ❑ Discretionary"D"or Unnamed Use Classification El Commercial* ❑ Special Use(Essential Public Facilities)*" ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** ❑ Home Business ❑ Cottage Industry ❑Binding Site Plan** Cl Propane Cl Long Plat** ❑ Sign .- ❑ Planned Rurai Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration" ❑ Stormwater Management Cl 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 Conference Please identify any other local,state or federal permits required for this proposal, if known: • DESIGNATION OF AGENT I hereby designate Richard L. Shaney It ' to act as my agent in matters relating toQthis application for permit(s). OWNER SIGNATURE � • t Date: / '� •aDO� 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 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 inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the appli at he or j- pri. •'i• � •-2 Signature: LL! �� Date: /p 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-transnTET onsibility f r a ,..n/g to n lying ithESA. The Applicant has read this dis ai er and signs and dates it below, Signature: CGZ Date: ` Z� G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc 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: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: LI Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System C Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: — Existing: Setback: I 0 Private well ❑ Two Party I Type of Heat: Proposed: ❑ 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 I No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: I Underground Tank I Above ground Tank Size of Propane Tank: I Heat Stove I Cook Stove I Woodstove i Fireplace Insert i Hot Water Tank j Pellet Stove i Other Is this appliance being installed in a Manufactured/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, including the reserve area. Square Footage _ Current Proposed Rot Office YO.'1.01111' Amount Ftevtsion Main Floor Heated EH Bld App Review: 2nd Floor Heated Consistency Review: Other Heated Base fee: Mezzanine I Additional Senior: �J Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL $ Receipt Number: Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DAD Forms\Master Permit Application 5-29-08.doc �1 f r'! f t... , W ^ i +`C 1----4-,,,,y,-s" 1 .:,1 1 't,1: at Aitit'll ,i4"-;7" .7 _ �► STAT,E� OF W A S�H,IN,G TO?N � i �y' .•' ;: 3 � .E� 64.. .-..2-,07.--..,,,.cf ,. r , z: ®EP A•R�T f�'E�N -,-,--0'F` W�E•A LST H � --41--0"A%----. i 1 \ 1 ) 1 ,:!:-.1 , , ". , t 4:N.".tai,.J A - a••^' ^e 1 e ,1 JM+' e1n'..!%�:`kits 'P�.°�M�.ISs>.°i,Gr rte i rw �e>s.�y -,i• 5----- - A L es-.''.,L -0:---&--4- t Y iF ,, ;y Local FileNumber t'1 Washington State Certificate of bee-8iStale File Number g�f - 1.Legal Name onmms taus r any) Firs -Middle LAST SNIu 2.Death Date ' ' 1 Elizabeth Ursula GI'BLER Oct. 19, 2009 s,Sex (MIF). - 4a.Age-Last Birthday 4b.Under 1 Yee- 4c Under,1`[lay 5.Social Security Number 6.County of Death - orro Female 82 Months Days '"'"irwrs Minutes 311-30-4293Jefferson .Birthdate 8a.Birthplace(Gry.Town,or County) 81).(State or Foreign Country) 9.Decedent's Education t Aug. 14, 1927 Brooklyn New YorkMaster's Degree 0.Was Decedent of Hispanic Origm?(Yes or No)8 yes.specify. 11.Decedent's Race(s) 12.Was Decedent ever in U.S. E. No Caucasian AmledForces? No 5+` ,; 3a.Residence:Number and Street tog,824 SE SF'St.)(include Apt.No.) 13b.City or Town 728 Adelma Beach Road Port Townsend 3c.Residence:County 13d.Tribal Reservation Name(t appecable) 13e.State or Foreign Country 13f.Zip Code+4 13g.Inside City Limits? /0' Jefferson N/A Washington 98368 ❑Yes Eo No Dunk 4 ..",:i14.Estimated length of time at residence. 15.Marital Status at Time of Death 16.Surviving Spouse's or Domestic Partner's Name(Give name prior to first marriage) 9 Years Widowed N/A 17.Usual Occupation(Indicete type of work done during most of working ate. (00 ROT USE RETIRED).18.Kind of Business/Industry(Do not use Company Name) Homemaker Own Home 19.Fathers Name(First,Middle,Last.Sumo) 20.Mother's Name Before First Marriage(First.Middle,Last) Florian Hartford Bran Elizabeth Mills - :'.r I.Informant's Name 22.Relationship to Decedent 23.Mailing Address: Number and sheet m RFD No. Deyo.Torm Sista Zip Maggie Kelleher Daughter 730 Adelma Beach Rd. , Port Townsend, WA 98368 4 e 4.Place or Death,II Death Occurred in a Hospital: .Place d Death,if Death Occurred Sornext,ere Other than a Hospital: t` N/A i Dau$hterts Home r r 5.Facility Name(d nota facility,give number&street or location) 26a.City,Town,or Location of Death )26b.State. 27.Zip Code 730 Adelina Beach Rd. , ti , Port,".-Townsend' I WA 98368' .41 r 8.Method of Disposition 29.Placa of Fknal DIspo8ition(Name of cemetery,crematory,other place) - 30.Location-City/Town,and State Cremation Kosec:`Cremgtory • - - -11 Port Townsend, WA s 1.Name and Complete Address of Funeral Facility ", "£ .nhi•r p 32.Date of Disposition vie Kosec Funeral Home, 1615 Park$icfe 'Dr. -Port Townsend, WA-98360" Oct. 20, 2009 • f s 1.Funeral Director Signator.X >�" $ ,'S e^ �y; r}gg' pj$� �I,/�rrli( . 0-/ % 2 s&^l, - tai., fir' d . Cause of Death Instructions and examples) IIV ' , . Enter the chain of events-diseases,injuries,or complications-that d) sed the death. DO-NOT enter terminal events such as cardiac arrest,respiratory arrest,or a entncular fibrillation without showing the etiology. DO NOT ABBREVIATE ditlonal lines if necessary. )ntervel between Onset&Death MMEDIATE CAUSE(Final disease or A,} L.�.r 1 w,, -I..ndibon resulting in death) -3 a- , Zc`�l5 i �4 1 C- big �-at N CQ r (1104'4'Lit 5 $ .r, Due to(or as a coriLequence of): Interval between Onset s Death 4 • p -'.equentially list conditions,if any,leading bSs o the cause listed on line a. Enter the• NDERLYING CAUSE(disease or Injury Due to(«as a consequence d): ',Marvel between Onset&peas, ?hat Initiated the events resulting in c. .:ath)LAST Due to(«e,a consequence of): )rllerval between Onset&Death d. • 4411 'e5.Other siollniflnl conditions contributing to death but not resulting in the underlying cause given above '36:Autopsy? 37.Were autopsy findings available to C sl pt g` trt.S10 VI e-'4: 2SY(u✓.� �t Qj 4-- , complete the Cause of Death?o / ❑Yes a No ❑Yes ❑No 1 IS ,j+8.Marine/of Death )39.If female 40.Did tobacco use contribute ' Ki Natural 0 Homicide $j Not pregnant within past year 0 Not pregnant,but pregnant within 42 days before death to death? l . 4 0 Accident 0 Undetermined 0 Pregnant at time of death 0 Notnant,but prig pregnant 43 days to 1 year before death Yes. 0 UnknoProbablywn =!°yy�` 0 Suicide 0 Pending 0 Unknown if pregnant within the past year /[Ifo 0 Unknown ?) s 1.Date of Injury(MMiaomw) 42.Hour of Injury(24hrE) 41.Place of Injury(e,g.,Decedent's borne,construction site,restaurant,wooded area) 44. Injury at Work? a12Yes ❑No ❑Unk Sti ;g 5.Location of Injury: Number&Street: Apt No. / p '..vs ay or Town: County State: Zip Code*4: 444, - 6.Describe how injury occurred 7.If transportation Injury,specify: Y s� 0 Driver/Operator 0 Pedestrian i� ,,.� 0 Passenger 0 Other(Specify) ^ ` '' -.- of knowledgedeath occurred al the I me,date and b.Medical Examiner/Comner- /i+a.CeeMyln• r On the basis place. and due to the causels investigation place and, 4a1 and rrfap r sled opinion,death occurred at the time,dale,and place,and due to the cause(s)and manner slated. t r N'Jt 1t '1 f4T5 '• V _ OFy C d.9.Name and Address of Certifier•Ph dan,Medical Examiner or Coron ••_ . 60.Hour of Death(24hrs) -1 Claus H. Janssen, 34 Sheridan Ave. ' °•_a5n +,;;'!F '-WA 98368 0530 Hours 44.4 1 i-.1.Name and Title of Attending Physician If other than Certifier(Type. ion lannna.r + n,a i52.Date i ned it . 0 nnin t. (?7-� op .Title of Certifier 54.License Number e1ey' I U. Cs File Number 56.Was case referred to ME/Coroner? sax', aa• , M•II 310 u. a 4� ° A Iles ®No , .7:a war Sig - a ,-' r .,-,..,-,_ '" - 0,0, a a '0 ao*,. •.,Date Received 1Minmomvv) -9.Rin ndme0fr%6P 1•,<r i . 'lfirf .`.. S,- ter* <, / ,IrS IS' S. RrT 9�PY4i9f RF C'D 3P4;.'iLE=1, �C �JTNiR.F .H:E ITHST T` e-S EF`�F E�1.0 ,F ES,�.M•,.'S H of TdHE �F.',. L��N,L Center for Health Statistics �H2GI�t , Affidavit for Correction P.O.eox9709 This is a legal Document. Complete in ink and do not alter. Olyv8pla,OVA 98507-9799(360)2364300 STATE OFFICE USE ONLY State File Number I Fee Number Initials Date Affidavit Number • Use the section below for requesting any changes on-the record. Record Type: ❑ Birth ❑ Death Li Marriage ❑ Dissolution 1. Name on record: 2. Date of Event: 3. Place of Event: (City or County) 4. Father's Full Name (For Birth): (Husband for Marriage or Dissolution) 5. Mother's Full Name (For Birth): (Wife for Marriage or Dissolution) The Record is Incorrect or Incomplete as follows: The Record now shows: The True fact is: 16. 7. 8. 9. 10. 11. 12. 13. 14. I represent the person as: 0 Self ❑ Parent ❑Guardian. ❑Informant Telephone Number: • ❑ Funeral Director ❑Other iSpecify) I declare under penalty of perjury under the laws of the State of Washington that the forgoing is true and correct. 15. Signature: 16. Date: 17.Address: All vital records are registered as received.An item may be changed by affidavit only once. Subsequent changes must be made by court order.The incorrect certificate must be returned within one year of the date it was issued to receive.a replacement copy free of charge. All changes must be established by documentary proof submitted with the affidavit Examples of documentary proof: Certificate of Naturalization Medical Record School Record Hospital Records Military Record(DD-214) Voter's Registration Card(if it bears an Insurance Records Birth Record effective date) Marriage/Divorce Records Passport Alien Registration Card(front and back) Birth Certificates: • 1. Only a parent,legal guardian(if the child is under 18),or the adult themselves(if 18 or older)may change the birth certificate. 2. The proof(s)must match exactly the asserted true fact(s).For example,if the affidavit says the name is Mary Ann Doe,then the proof must show the name to be Mary Ann Doe.Mary A.Doe or M.A. Doe does not prove the name is Mary Ann Doe. 3. Proof must be five(or more)years old or have been established within five years of birth. 4. Up to age one,the parent(s)or legal guardian may change the child's last name with an affidavit for correction,provided: - This is a one time only change.Subsequent changes will require a certified copy of a court ordered name change. - The new last name may be the mother's maiden name or father's name(if present on the certificate)or any combination of the two. - After age one,last name changes require a certified copy of a court ordered name change.Minor spelling changes may be made with an affidavit and documentary proof. 5. Parent(s)may change their child's fiat or middle name by completing and signing an affidavit for correction(until their child's 18th birthday). 6. This affidavit cannot be used to add a father to a birth certificate.(Use the paternity affidavit-form DOH/CHS 021) Death Certificates: 1. Only the informant,the funeral director,or executors/administrators(if evidence confirming such position is presented)may change the non-medical information. 2. The medical information(cause of death)may be changed only by the certifying physician or the coroner/medical examiner. 3. If it is less than sixty days from date of death please contact the county health department where the death occurred to make changes. Marriage/Dissolution(Divorce)Certificates: 1. Personal fact(s) (minor spelling changes in name,date or place of birth or residence)may be changed by affidavit(with proof)by the person. 2. To change the date or place of marriage or dissolution,the officiant(marriage) or clerk of court(dissolution)mu DOH/CHS 023(Rev.9/2002) CERTIFIED JEFFERSON COUNTY • PUBLIC HEALTH OCT 21 2009 I he ureas Locke,M.D. • Health Officer RR00540571 FILED 2 09 OCT 22 PM 2: 03 JEFFERSON COUNTY 4 RUTH GORDON. CLERK 5 6 7 IN THE S PERIOR COURT OF THE STATE OF WASHINGTON 8 IN AND FOR THE COUNTY OF JEFFERSON 9 In the Matter of the Estate o ) NO. 0 9 4 00 1 1 0 10 ELIZABETH B. GIBLER, ) LETTERS 11 ) TESTAMENTA Y Deceased. ) 12 13 STATE OF WASHINGTON ) )ss. 14 COUNTY OF JEFFERSON ) 15 WHEREAS,the Last ill and Testament of ELIZABETH B. GIBLER, deceased was on the y of 16 October, 2009,duly exhibited, proved and recorded in our said Superior Cpurt; 17 AND WHEREAS, it . spears in and by said Will that EDWARD M. MILBOURN is hereby appointed as 18 personal representative therei and said EDWARD M. MILBOURN has duly qualified. 19 NOW, THEREFORE, know all persons by these presents,that I do hereby authorize said EDWARD M. 20 MILBOURN to execute said ill according to law. 21 WITNESS my hand a d seal of this Court affixed this gar-day f October, 2009. 22 RUTH GORDON,_ 23 Clerk of ouit " 24 By: w Ail �� 25 Deputy�R 26 27 23 RICHARD L.SHANEYFELT ATTORNEY AT LAW LETTERS TESTAMENTARY 1 WHERRY sWA 98 PORTT TOWNSEND,WA 98388 Page 1 of! (360)385.0120 1 FI1.. ED 2 09 OCT 22 PM 2: 02 3 JEFFERSON COUNTY RUTH GORDOA CLERK 4 5 6 7 IN THE S PERIOR COURT OF THE STATE OF WASHINGTON 8 I AND FOR THE COUNTY OF JEFFERSON 9 In the Matter of the Estate o ) NO. 0 9 4 0 0 1 1 0 0 10 ELIZABETH B. GIBLER, ) ORDER ADMITTING WILL TO PROBATE AND ESTABLISHING 11 Deceased. ) SOLVENCY 12 13 The Petition for Prob. e of Will and for Order of Solvency of the above-named decedent has been 14 presented on behalf of EDW• I'D M. MILBOURN,Petitioner,now,therefore,the Court finds: 15 l. ELIZABETH B. GIBLER died on October 19, 2009, in Jdfferson County, Washington, was a 16 resident of Jefferson County, ashington, and left real and personal prop rty in Jefferson County subject to 17 probate. 18 2. Decedent exe uted a Will on December 8, 2004, in the p esence of competent witnesses, and 19 the Petitioner, EDWARD M. MILBOURN,has been named therein as pe sonal representative, without bond 20 and with nonintervention po -rs. 21 3. The known a-sets of the estate are valued in excess of the known debts. Petitioner believes the 22 estate to be solvent. 23 4. The decedent was a single woman. The following are her heirs at law: 24 • ELIZABET I M. KELLEHER Daughter Adult 25 • MICHAEL STALEY Son Adult 26 • JOHN D. ST• LEY Son Adult 27 28 RICHARD L.SHANEYFELT ATTORNEY AT LAW ORDER ADMITTING WILL TO PROBATE AND ESTABLISHING SOLVENCY1101 CHERRY STREET PORT TOWNSEND,WA 98368 Page 1 of 2 (360)385-0120 a 1 5. Petitioner requests the appointment of Richard L. Shaneyfelt, Attorney at Law, 1101 Cherry 2 Street, Port Townsend, WA 98368 as Resident Agent for this estate since Petitioner resides outside of the state 3 of Washington. Richard L. Shaneyfelt is the attorney for this estate and has agreed to serve as its resident agent. 4 From the foregoing Findings of Fact the Court makes the following: 5 ORDER 6 1. That the offered Will is established as the Last Will of the decedent and admitted to probate; 7 2. That EDWARD M. MILBOURN is appointed as Personal Representative to act without bond 8 upon the filing of the Oath of Personal Representative. 9 3. That EDWARD M. MILBOURN is authorized to serve/administer and close this estate without 10 further Court intervention or supervision as provided by RCW Chapter 11.68. 11 4. Richard L. Shaneyfelt,Attorney at Law, is appointed the resident agent for the estate. 12 13 DATED this qi day of October, 2009. 14 CRADDOCK D,VERSER 15 JUDGE JUDGE/COMMISSIONER 16 Presented by: 17 18 , p (/J// r' 1 I'-. , 19 RICHARD L. SHANE FELT, WSBA#2969 Attorney for Pers na epresentative 20 21 22 23 24 25 26 27 28 RICHARD L.SHANEYFELT ATTORNEY AT LAW ORDER ADMITTING WILL TO ROBATE AND ESTABLISHING SOLVENCY 1101 CHERRY STREET PORT TOWNSEND,WA 98368 Page 2 of 2 (380)385-0120 JEFFERSON COUNTY w11Nc°6 DEPARTMENT OF COMMUNITY DEVELOPMENT Jg, ti vo ►C 621 Sheridan Street 4416,4101P# Port Townsend, WA 98368 October 9, 2010 Al Scalf, Director Dear Reviewer, RE: MLA10-00344 Jefferson County has forwarded the attached application to you for review and comment because your agency is responsible for determining compliance with state and federal requirements or may otherwise be affected by the following proposal: LAST WILL & TESTAMENTARY DIVISION Location: Parcel number 901 051 003 & 901 042 006, Section 5, Township 29, Range 1W, WM, located at 730 Adelma Beach Road, Port Townsend 98368 Comments must be received within fourteen (14) calendar days or by October 23, 2010. If no written response has been received within fourteen (14)days,your agency will be presumed to have no comments. If necessary,the UDC administrator may grant an extension of time for comment. Please contact at (360)379-4450 if you desire an extension of time or have additional questions regarding this proposal. Thank you in advance for your attention to this matter. Sincerely, c: Building Permits/ Inspections Development Review Division Long Range Planning (360) 379-4450 FAX: (360) 379-4451 October 9, 2010 Dear Reviewer, RE: MLA10-00344 Jefferson County has forwarded the attached application to you for review and comment because your agency is responsible for determining compliance with state and federal requirements or may otherwise be affected by the following proposal: LAST WILL &TESTAMENTARY DIVISION Location: Parcel number 901 051 003 & 901 042 006, Section 5, Township 29, Range 1W, WM, located at 730 Adelma Beach Road, Port Townsend 98368 Comments must be received within fourteen (14) calendar days or by October 23, 2010. If no written response has been received within fourteen (14) days,your agency will be presumed to have no comments. If necessary, the UDC administrator may grant an extension of time for comment. Please contact at (360)379-4450 if you desire an extension of time or have additional questions regarding this proposal. Thank you in advance for your attention to this matter. Sincerely, c: , October 9, 2010 ELIZABETH B GIBLER 728 ADELMA BEACH RD PORT TOWNSEND WA 983689282 RE: SITE ADDRESS:ADELMA BEACH RD MLA#: MLA10-00344 Dear ELIZABETH B GIBLER: Jefferson County Department of Community Development staff have reviewed the application materials for the above project proposal and have determined that the application is substantially corn plete. Additional information needed for project review may be requested in writing by the Director or Project Planner. Please call the Department of Community Development if you have any questions. 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' jo II um ry 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 Sep 13 15:59:31 2010 http://gisserver/servlet/com.esri.esrima .Esrimap?ServiceName=ovmap&ClienllVersion=4.... 9/13/2010 Map Output Page 1 of 1 ArcIMS HTML Viewer Map 09132499,-.- OD'124(n6 90,329012 -- 00024052 ) 001321063 001324090 00,3339„ 111 �' 99,32,9,:—__ + T —- �, r -00,32100 --- ---_-00,3z.070 _ i f 20051005i eV -___-- ---` / 901051013 + - -1 1 90'051909 7 00,06,019 -__----- �i ~. '. Cv_V AC� + ! / 901091009 J i I 901091003 / 1 29'05,0.21 Legend 9C+0610,6 Selected Features ¢g ______Y .. JC Roads ....051013 F, I Parcels-H < .._-. Lots 1: g0,054,,— 9W051(121 i I —9010510:9 I 901042006 / V / 90,06190] +' r / ri 901094 +1 t I 904051004 / i (/ 901051010 _- �------ -_. ._ / a- I 9.24WO% 901092.X:' 901051919 / Na WOMBS WJe,Mam Carry Crew.*Sereas GC 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 colection.Mon Sep 13 15:59:45 2010 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&C1ieutVersion=4.... 9/13/2010 . , Map Output Page 1 of 1 ArcIMS HTML Viewer Map cdi 124094 021324049 OW 324048 00'324043 , 001324001 SX/*324042 00'1,4044 Mr 324046 00/324062 001324054 00132404* 00'324006 00.3240W C013130,• 5,L+0,-,,,' OD'•1 s'sx, "orl Al . CC'044030 ,e3.024038 / (),-,1.2 4 CI 7 ---=-1 ii / 9.:,'05'009 ,:','. ,,,,,,.„., Ca 031051007 , af: 901051017 af 901051016 LegeSelected Feand / hmes _, JC Roads Parcals-H 4C,i i'aZI: 1 Parcel Tags-H 90,06 4 r 901042006 IIII So.ca flarn , 93'05'003 I / 90'04200' I I , 2- ',,, i10104200q ovdrIli4.1414rsen Ceser Cove4 Scroces GIS 001018•011 •45Pft 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 Sep 13 16:02:56 2010 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceNarne=ovrnap&ClientVersion=4.... 9/13/2010 • Map Output Page 1 of 1 Arc IMS HTML Viewer Ma. 001334044. • 001324O44 979790001' 001324049: 90 324049 I 00131404: 001324662 I .. Or 324060 i 00'324003 00132409' 00'31400f 90131g0u 001330164 001321045 1 11. a 24042 4 1 IO . _... . W 90'324053 ir 90131460 I •i Od1324o4 9010510134091 — 090132924 901051005 JJ r _.._._.___ 901051019 f 901051009- f��,.) .. 4' .1: 901051007' Q9 w'atm93+ Lego nd 901051012 8 Selectee Features 116--""""" 9010510.5 90.051013 y JC_Roade yb` PdrGe1641 1051011 sP. 901051020. l Permite44 991051021 . $V:US•G 1C 991042/906 901051003. •��A,�J� s /901061010. aa s. .9°'29, Y• M.:errcraolor.Misan Oonycoaa 9meae GO 901051001. FOR INFORMATIONAL PURPOSES ONLY- Jefferson County does not attest to the accuracy of the d'ta 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 c.11ection.Mon Sep 13 16:03:08 2010 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&Cli ntVersion=4.... 9/13/2010 • . Washington Coastal Atlas Photo Disp:ay Page 1 of 1 WASHINGT011 STATE - --- Department Department of Ecology Coastal Atlas ' 4, • _ it t.— 12-'"ti r" i 3. 4 . $ - 0 Vo"* P t 7 , }} I f. ' '` � J� _(aj i '""�v '3 'A # 'nt { i 1.a.♦• ' it i 1 ,,..,t s ,: � � : C ,i dt � ' ii A _ Irv., - . 1 ` " '. 41 Photo 060623_00923 Date: 6/23/2006 Area: Discovery Bay Reference: Panel Download links for this photo Low Resolution 800 x 531 Iixels r9Kb High Resolution(4288 x 2848 pixels, 3894Kb) Approx. 11 seconds for 56kbps modem;2 sec. ds for Cable/DSL Approx. 9.3 minutes for 56kbps modem;82 seconds for Cable/DSL View photos of this area in other years: 1940s 1976-77 1992-97 2000-02 �' — https://fortress.wa.gov/ecy/coastalatl hoto/PhotoDisplay.aspx060623_00923&vinta... 9/13/2010 •Map Output Page 1 of 1 • ArcIMS HTML Viewer Map N019 y.1,r .. "I 131a061 y�Eif�"S'J' ROQ'32aQ] 14 51nvat .. _i _ aQ1 i2gCYa _ �-� c A2,1041991Y1aen• `, CO.32400' a0.32n0cc 001113011 [ (Z i.C'Y33.1u Y ]1412 I =0'324052 CC 124053I OD'32MY.' 1 ! T l:'31M\m. ....: — 0Ut 32aG1! 2W38 32.417W WOOS 1 901051014 T_•-9'0.0_ r 9Dte51e19 . 1 ? 1 2~--— 9-•"5•(X"9 90tOS•OOD 90•M20-4 ---7 Legend QC 9J'Ut,:e ' Selected Features 3'J.r5'..'1 a 9)1091017 901051018 is Roetle IParcels41 Shorelines#res 9 _ T �9009'620Cpls¢nmclt9eWAan f �'•�'•'1• 9010510/9 ,A/ consw.mrn'eau.m 90,0430% U.... a01951999 r/ s„tl.ban 9r."MZ...*" �/ Hatwe _,e cenaevnw emurs's.bu.b:l 91n0sum '•/ se+ns'o'c /`/ Other /1 usrola i1r 90101200• i ' `" 901051018 i I . %1.:at a-weaat e'e:rIC,,, .,c...-.A5 ;' 0nflelile4911-1 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 Sep 13 16:03:21 2010 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&C lientV ersion=4.... 9/13/2010 Map Output Page 1 of 1 ArcIMS HTML Viewer Map 004114044 __ :ZAJ14 ti•c/vr:Y 01'3]24049 tU'32a019 0. z.1(48 00/1240522 I il 32404/ )1 il 2•W,] ,324084 �.32MN5 -._.- ,i 001353011 I .. 001 -a u�c•Iz sz19+, YP I .M'324080 I v 3240 90 O5'IXM ( 20,05'0'S 90tOSt006 g L _/Y t �fO510t9 59 951009 901051004 --. -r ar i 1O 04 O3 Legend OD'34[41,4,4S7 901O9t0+2 �� S,p,,,t011 491051018 / f �,,s Selected Feahres 901051013 . ... ( 1 �— JC_Raade 2,4_01'011 re —� Parcels41 ""'^901051921 10105'(20 DNR FP Stream 901051016 Claa4irication 9915ax9s Al F Fim tlmnai 901051003 V NNenIM llmna 90101]001 .y/ Ne.Nen.IM llmayPpannW lN. Nan fat,IlaInts Seasonal /',J" „4/ s.w.en,erm Sno.mnp 49,.41494 99,os+olo J/ii,f` i I • 1 991051018 /' ;" 40,042001 491051015 jar , i ,I.via*dt.v.VN.av,CanyCawadmrce,32S . ..- -.. 0aaaaaaaaaaaaaa�X19111 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 Sep 13 16:03:37 2010 http://gisserver/servlet/com.esri.esrima 9.Esrimap?ServiceName=ovmap&C1ientVersion=4.... 9/13/2010 . Map Output Page 1 of 1 ArcIMS HTML Viewer Map 00.3.245.1.1 9/5/0005' 00,92.15.15, ' ."?.:'Jz.1...S.15. El 00,329,-4.8 C r .X-3.2.1,fiz. IF X' i''.V.X...1 i Ir, C"32lCt-' tk'12.1.55* 'X:,.129052 0013.11/tt* . Or'120105.3_j I .X.'324:4C. : , 120311 I .S:.'324,5, X'1:2909! _ 00nr*.‘1! 5+0'05'009 ' 90'05''fXSO 5k."5,125,5.1 skIl_i.jeedgen1 - Features II II-I-IIIIII 8 017 . 2. SK,../5'0''E. 901061011 4' w•chyczc. II 1061021 "molls J.;pp„..c.::9:.o at Streams d.Hs 021042006 901051003 Irrrua 90.04AM 901. 1004 ,, 101051010 / r ..4 ' / I I 994061018 031082091 .1 / 909261015 I A 10Entrooded8i.efersolCo.nyCeva a2I.,'=.SIS 0 Nimosos49111 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 Sep 13 16:03:48 2010 http://gissenrer/senTlet/com.esri.esrim.p.Esrimap?ServiceNarne=ovmap&ClieltVersion=4.... 9/13/2010 . Map Output Page 1 of 1 ArcIMS HTML Viewer Ma. 00'32.1041 ._. 0,319 -' -. :0.32151 xV 3240-1' 1 (X1',14,10.1' , - i JC"3i4Vfle --- �4'x3y,u -,(1 90132.612 — R"324052 :1_03 x:-324030 FF fi 00+324038 00132400 1 - ,1.12x0/ 90/051006 90106'0'5 +/.05100 ' 6 + ' 601061009 20'0.12,Y.'1 9010.X03 1 r Legend 9`-''''''''''' .5" 901..Ot) J t Selected Features 901051016 /J JC_Roads 901061013 • tt �- -_-_ ,:_ _ _ t Parcels.H "051011 r,,' ,1051020 , DNR Water Doilies 901051021 901051016 ' a ® r . 901042006 ® N / 901061003 ■ c i }f 90194DJ01 ❑ N:Dcs,4+n 190'1. 1094 6610610104 1/ 9010.2001 . / 901051016 ` 1 l MaalvmddEy.aAaa01CwyCa/tl6vana GIS 901051001 ,/t 0�1N10 FOR INFORMATIONAL PURPOSES ONLY- efferson 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 ma.is limited b the method and accurac of its coli-ction.Mon Se. 13 16:04:00 2010 http://gisserver/servlet/com.esri.esrim:p.Esrimap?ServiceName=ovmap&C1ierltVersion=4.... 9/13/2010 r • Map Output Page 1 of 1 ArcIMS HTML Viewer Map UL'09049 -...:•'MVH '-971 _ r IS 991BpMFq � i �._'sx.99 I 00,899095 OW010E4 1 0C 001]59001 _L 04005001333011j 9013110112— -:Cl 00155909] _--. ri'Se.1CS1 01554055 1r:.u9p90 ... 00132400 t 00'01070 81055909] -- l v.)1050135 '051015 95 655008_ 901ne0ts 051009 9 35'09' [d201-1 0'05'001 , tlaC 90109]005`. �p Legend € q" Selected Features Gee 90 10,1 +1 90105,016 / 1_____._—_. - JC_Roatls 1 c � Parcels41 _ -+— 1 C 9'"05'.039 ! Sollsil 99051021 901051919 � 901090008 / + 991051995 � // 9014200+. I l /Po1019c ////L ( /1 I 9010810 1 1 ! I, \ f i 99,91018 1 t ti 11 1001 / j `r 0 %1, u. 9010 989^ Mm aa.mMq udvsm CeWaere aSaaom G!g li 99511 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.Da:a contained in this map is limited by the method and accuracy of its collection.Mon Sep 13 16:04:13 2010 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&C1ientV ersion=4.... 9/13/2010 • Map Output Page 1 of 1 ArcIMS HTML Viewer Map CY1'121011 r PLor1XO' 001126002 "11.,119011 CU'32.105.2 CO'32•10£4 001324043 CO'12400< ce 124COer '10'133052 ".11 CO'12,1012 r / 9O,O51CO r<1,1012 1111111111110,k' 0013240',1 LO1051018 90-051ca1 , <1Z05100? W1'092001 <27' r Legend Selected Features JC Roads - / Parcels4.4 Hentage Points W'041COE 92' ••••••• -••••••4941 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 Sep 13 15.04.26 2010 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceNarne=ovmap&Clien!Version=4.... 9/13/2010 • Map Output Page 1 of 1 ArcIMS HTML Viewer Map 001324014. c,eroatr 00112400 WI 324X6 601324002 601324064- V1324043 00132401, I1 Cot334001 001324006_ Cq'33301• 00'331%2 `6 00,324043 601324063 .._l— 001324000 00212406, r• __ 1 01 n4030 001324024 1 . 07'121047- — -001324017— / —_... 1 00•4151006 611661013 I i 07 051666 % 931661019 1 I 911061000__ , 00+612014 • I 1 10010420031? Legend t1 - ` s ,20.041017 �, 1/� Selected Features 9016510,6 JC Roads ' 1 ParcelsA 901051020 / 1 Bald Eagle Nests 1 -- -- 901061016 Bald Eagle Butler. 901041004 - t3az Burn. i 901059006 e70 BBOo. / 40104200' 900 wsna.eMe Buffo, Jf 610 96 051 __C•3 �_-1421" , 961651016 1 , I Mm.r'ind.E^I.a1bw1COSMCvweec+.a._- - 49,1t. 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 co'lection.Mon Sep 13 16:04:43 2010 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.... 9/13/2010 . Map Output Page 1 of 1 ArcIMS HTML Viewer Map 00r32404 001324049 : 001124044 I 00,324093-1 I 00'124001 I ar 301006 0013330,1 , ,,,,,ow -.411 001324042 - 031324092 - 1 _001 ____ .____,i I 00,324093 I 3:14020 , 1 . ---- 001324019 C01324070 --1 iii OW 124041 1- --001320017-=--__ Iii 00105'00S ' ll 001061015 7 00105,(105 I I 001051010 i / . 90',051000 _ , 001051000 — , 931 , 90,06,0°7 / 1 00102003' / Legend 031(Wer.2 6- ' w.,,,icn, 1 , 0 Selected Features ef 90103,016 1 ) 50.09,9'3 1 , Pa rce Is 41 90'05'0" .P W0031020 „ El Wetlands f 900,s0.1. 901051016 ' 0 a I 90105,003 / / if ' 901042901 901 1001 , 901031013 , 901042001 \ ' 00,051016 7 1 A 90'OS'CO' 110.00.040 oseaval Carkh Coen Serra,GS 0 11111•149th 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 Sep 13 16:05:12 2010 http://gisserver/servlet/com.esri.esrirnap.Esrimap?ServiceNarne=ovmap&ClientVersion=4.... 9/13/2010 _ I . Map Output Page 1 of 1 ArcIMS HTML Viewer Map _02 324044 1 __- 001124.44 _- 001324049 i 00.124049 001324049 001124062 0013240424-- — ,-.001324143 001324064 001324001 1 001324005 021333111 _ _- -----1 32+042 00132453 001134038 .-- 00t3241M i /021324017 1 —..-_00,3290 _ t 00105,003 901061015 --- i 50'01 040_. - 00,051019 i , 3 ' A"OS L[}9 901051029 i tI 001 I W. gplanr,.. I Legend 1 90105142 0 Selected Features 90109100 01051018 --_ � ,✓ JC_Rnads 051013 i p' Parcels-, `r U P 901051030 J t I 1 salsmic Hazard 901051018 i • 901042006 991051903 i 40195}004 'l ery I � 9010610,0 ( \� 90106,0,0 i I 901061021 11xn s...wao.�ci-w.ce,� <rn a.+m6iG 0 me41, 4915 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 Sep 13 16:05:29 2010 http://gisserver/servlet/com.esri.esrimap.Esrimap?S erviceName=ovmap&ClientV ersion=4.... 9/13/2010 • Map Output Page 1 of 1 ArcIMS HTML Viewer Map CC 324&l1 __ srYI _.�!r.Y_r.• 0C'324094 -:]'324019 0013291.518 •D•82462 _ _.-. . ..}•321941 1 W'13AW' OW 333052 1 W321CCG 0523332)•• CO-3240U I' 051324052 _. 1 _._ r rY,.17 01324]80 I 1` 901051015 1 I Z� 9o+a5oror j ij t�.. 051321947 _ 401981020 , 90,85309. 45,os,0a9 , 4'1-CS•W9 901042004 'XXM Uv Legend 9010510 1 H 9010OH 901051015 Selected Features 901051013 �__ ___ _ JC Roads _ - - .___.� ullParcels-H 0 90,5' '1 rpe'9' 901081020 aslide Hazard --901001021+rte 9010510+s Sees r • 501943035 tips II 90+05100 Maewwe Slq n1 L 40105101 (I 4:'CS'�':: R 901051018 - 11055.0(10,J 1 90105/015 f III +am.trended try,ae,a.ce..rcoea Senems;1s `-„a'< 'i' a 1=MMIONIMI. 49111 FOR INFORMATIONAL PURPOSES ONLY- Jefferson County does not attest to the accuracy of the dacontained 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 col ion.Mon Sep 13 16:05:41 2010 &C1ie http://gisserver/servlet/com.esri.esrim. .Esrima ?ServiceName=ovma tVersion=4.... 9/13/2010 p P P � Map Output Page 1 of 1 ArcIMS HTML Viewer Map iX 324044 04'11.1041 g'd,51.4.1, 00"141414 'i 031124049 031324062 .--—__ 001324064 00324043 — 001324044 4•12 ,,' t± -41 o .1CO',30' ; 324 0:6 ...v.,3.!..15.2 351054 , • . ...'0' 24553 r ' ' .r i )0'11•141, ,` -=---21 CC"t',04,'..,'(,,,H, — I__ . 90105,0-5 1.. 941!5'1406 ' , 90051019 I I gCn°5'-C.31' — /I_ _ 1. / . 9010610:17 4 F--- 4;',/ S04512003 Legend •—931011012 rzi &sleeted Features , '! ly 901^ 1017 9010610'6 j .• ,,„; JC_R0ads i, 9)1061013 *47, Parcels-El 9010610,1 40 901031020 FEMA FIRMS 901061021 i 901061016 " A . , 901042006 Aox 901061003 le Aion 90104200, 1. Omar 4 • S*106100411 43'05'0'0 r. . a , , ! .• 1 90i039013 90'04200. Ii 00106101*ta , I, . 001051001 %lea;model ay rieforreCesty e.t.a Serncen.G1$ 01• 11140111 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 contaned in this map is limited by the method and accuracy of its collection.Mon Sep 13 16:05:54 2010 http://gisserver/servlet/com.esri.esrim.i..Esrimap?ServiceName=ovmap&Clien Version=4.... 9/13/2010 . Map Output Page 1 of 1 . 1 ArcIMS HTML Viewer Map I 001124044 1 00'124044 91070000/ I 0013240e0 ,o1s2agaa _ _001 32-00, I ---' ?--- 00324084 . 1 •013240/11__ F_ _ ,l C0•124001 . ---- _ I ,X132404.1 ----- OD'124051 0013240110 ' 00132411138 0:113.24070 .--- \---- ri° _ .-- -,...„.........„,„.„," 9010510M 4- 901051015 901051008 901051010 _.--1".-..."-..-..- 9:"6""" _ Z-------------------90'012eX4 _ _ r------,e\----.., . 901042003 , 90406'0,;(/\00.051017go•.Vgeogig , Legend CI Selected Features / i 901051013 90105-1011 ' / T90105102 ) 901051020 901:10041°"3 1 90105101e 90442638 / ,1 901051010 90/012001 ,,, JC_Roaels E Pamels-H . Critical Ag idle r Recharge iiAreas SU ,uStx-UNK El "ss:.SL'X ESA liP/a•1.1111.1 /t/ ,' 9010E0014 90.042004 ' 1 / 901051018 1 / . 1 ' . j 901051001 ca...hIsItyJasadtavContiCerild 8e•-•••NeGIS _c=assesNIMMIll 49111 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 cc lection.Mon Sepia 16:06:08 2010 http://gisserver/servlet/com.esri.esri ii ap.Esrimap?ServiceNarne=ovmap&ClicntVersion=4.... 9/13/2010 . Map Output Page 1 of 1 ArcIMS HTML Viewer Map i' 001324044 1 007124049 1''' 001124048 001324042 00112400' 1, r - _ "...--11,,,121,1 02'1..4C62 _00132•3S4 — 001324041 001324006 0213.13011 .- ll 0011.2.092 ! 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El eel,R.SIM El c.a../SiP2 921042001 9011 1004 / 1 901011010 ( '4i:5:. 1 11 \ 901051011 'r , . /1 : 909011078 I' 90'04200' 9(2•16'CO, Mem aNardocrn.ceo-lcn Carl Caltr•SernmG1.9 i 4511(1 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 Sep 13 16:06:28 2010 http://gisserver/servlet/com.esri.esrim.j•.Esrimap?ServiceNarne=ovmap&ClientVersion=4.... 9/13/2010 Map Output Page 1 of 1 1 ArcIMS HTML Viewer Map :\:•!1.1'.'14 v,-]24C49 I (I i ,:,:'12.1C-.18 __ !1.YF.. iY !2.161! -•�NiN• ( W'1b1441 t ;) X'.!2,V,..-! ..."'-' ,.Y".:-12j 4'cw•6;! / 1 I Qa / se•alras- Legend ' Selected Features 4 JC_Roads __ _ / q. / Pa rce lski -, ".!±',_•'"/JTom gp,p.,;, Shona line Slope Stability t Apppormr- SeY YJ 6 E Stow L2'612pp6 O 90'12, W! ❑ u.1.1. 141 5b1W1Ge1 ■ Jnnae.Flamm Lanae f O Jnnark Ob La OSMC ® Meeflee IIII \ i ' w•cn•u•e v.�•w.w• ,.4,.”05',.Y8 i N:u,.ru.ddarmaoun Cavy Calve snv,me Gt5 f x'•m�co. o®�.. ns•n 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 Sep 13 16:06:43 2010 http://gisserver/servlet/com.esri.esrim.p.Esrimap?ServiceName=ovmap&C1ieitVersion=4.... 9/13/2010 Map Output Page 1 of 1 ArcIMS HTML Viewer Map X..r W2ni:l.l _:..1:11 _•;..,.;;, o_. _ • 1 e° Y�•sizA'' Lege nd Selected Features -- - FT Parcels#I 440 J^� Ai YC OS Y�c Y:'f1t/,ZCVE J 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 cqllection.Mon Sep 13 16:07:04 2010 http://gisserver/servlet/com.esri.esr' ap.Esrimap?ServiceName=ovmap&C1iuntVersion=4.... 9/13/2010 Map Output Page 1 of 1 ArcIMS HTML Viewer Map 'na•un041e.5.', er+c.'S...AA+ 1I 4. ,;.X.r ■1i `.�•.. .rs .. — I � � iyK�y]e.1;N4 ��, � ._�.n�Kao i `mii ' J • 1 . 11/411.1: ,i t 'e h.a{ r•IS•'a` LA•1330• CC:„Y]b2 '•11"h� x u�:ruiz a SAO,/ 1 ilri x 3rncro L_'1A0•1. 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I - b•x .•n wi i o 0 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 Sep 13 16.07:18 2010 http://g i sserver/servletIsom.e sri.e srimap.E srimap?S erviceName=ovmap&Cl i ent V ers i on=4.... 9/13/2010 Map Output Page 1 of 1 ArcIMS HTML Viewer Ma °EP . y I• GSM 1 Es= •i . a ,... /i .�� r __. p_t _-q CUED F f ArIa• Legend o r_ ,_ T Selected Features ` JC_Roadc 5?10 4. 00414. e. Parcalsa/ 90[S_'s 2009 Aerial Photos • 9u arwe `+ A'04,,:, OEMS CZ 01.-S[if i Mn wooded. JestrsolCo.roaCeleaSeresesG19 FOR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the d. - contained herein and makes no warranty with respect to its correctness or validity.Data contained n this map is limited by the method and accuracy of its colt lion.Mon Sep 13 16:07:44 2010 http://gisserver/servlet/com.esri.esrim. e.Esrimap?ServiceName=ovmap&C1ientVersion=4.... 9/13/2010 http://www.cojefferson.wa.us/assessors/parcel/valuationdetaii jjJefferson C • ou ty 141.3. 4141 3 & Marne �� County info ;ar Departments a� Search Valuation Information for Parcel Number: 901051003 Assessed Fair Market Value Property Sales Information Improvements: $261305 Affidavit Number: 0 Improved Land: $270000 Legal Document Description: BLA #73694 & 73697 Unimproved Land: $418860 Sales Amount: $0 Taxable Value: $950165 Sales Code: *** DONT FORGET ASSESSMENT IF LISTED BELOW!!! *** Current and Prior Year Taxes (Add Assessment to Tax Amount if any listed below) Tax Year Tax Amount Taxes Paid 2010 7470.74 3735.37 2009 4710.84 4710.84 2008 3781.6 3781.6 2007 4173.82 4173.82 2006 4564.74 4564.74 2005 5136.32 5136.32 2004 4705.98 4705.98 2003 4921.18 4921.18 2002 4887.82 4887.82 2001 3480.74 3480.74 * ASSESSMENTS: Port Ludlow Drainage or Clean Water (Add to Tax Amount for Total Amount due) Year Tax Amount Taxes Paid 2010 5 2.5 Property Transactions No records returned. NOTE: This is for informational use only. Do not pay taxes based off this information. Please refer to your current tax statement or contact the Treasurer's office at (360)385-9150 1 of 7 8/27/2010 2:31 PM 1 lAotoly http://www.COjefferson.wa.us/assessors/parcel/valuationdetail.asp 4'4 ount *- Jefferson y nFry""" `5' ✓$'°"�X c",� r'.-ac . x :c- iCv '"rs'es. a �2„ce +nr' i-axs.:.�.,.�M ' s' da-r ¢ , r 15(x. Departments Search flil1e {IUI) IDepartments Valuation Information for Parcel Number: 901051023 Assessed Fair Market Value Property Sales Information Improvements: $0 Affidavit Number: Q Improved Land: $0 Legal Document Description: BLA #73694 & 73697 Unimproved Land: $0 Sales Amount: $0 Taxable Value: $0 Sales Code: *** DON'T FORGET ASSESSMENT IF LISTED BELOW!!! *** Current and Prior Year Taxes (Add Assessment to Tax Amount if any listed below) Tax Year Tax Amount Taxes Paid 2009 472.32 472.32 2008 503.84 503.84 2007 585.7 585.7 2006 550.62 550.62 2005 576.84 576.84 2004 588.52 588.52 2003 620.96 620.96 2002 629.62 629.62 2001 2093.68 2093.68 * ASSESSMENTS: Port Ludlow Drainage or Clean Water (Add to Tax Amount for Total Amount due) Year Tax Amount Taxes Paid Not applicable for this Parcel Property Transactions No records returned. NOTE: This is for informational use only. Do not pay taxes based off this information. Please refer to your current tax statement or contact the Treasurer's office at (360)385-9150 1 of 1 8/27/2010 2:32 PM littp://www.cojefferson.wa.us/assessors/parcel/valuationdetail asp Jefferson County L—6 ,t,. s .* .:tet-ter+. o.az^ cs-5u x r.:s✓ ® dome County info Departments Search Valuation Information for Parcel Number: 901042006 Assessed Fair Market Value Property Sales Information Improvements: $0 Affidavit Number: 0 Improved Land: $0 Legal Document Description: 179/451 Unimproved Land: $850 Sales Amount: $0 Taxable Value: $850 Sales Code: *** DONT FORGET ASSESSMENT IF LISTED BELOW!!! *** Current and Prior Year Taxes (Add Assessment to Tax Amount if any listed below) Tax Year Tax Amount Taxes Paid 2010 6.68 6.68 2009 6.78 6.78 2008 4.44 4.44 2007 4.9 4.9 2006 5.16 5.16 2005 5.82 5.82 2004 6.06 6.06 2003 6.34 6.34 2002 6.3 6.3 2001 6.5 6.5 * ASSESSMENTS: Port Ludlow Drainage or Clean Water (Add to Tax Amount for Total Amount due) Year Tax Amount Taxes Paid 2010 5 5 Property Transactions No records returned. NOTE: This is for informational use only. Do not pay taxes based off this information. Please refer to your current tax statement or contact the Treasurer's office at (360)385-9150 1 of 1 8/27/2010 2:30 PM CASES, FINDING, CONDITIONS, PERMISSIONS FOR • Parcel 901051003 Printed: September 13, 2010 Cases Name Review Type Status Planner CAR00-00311 GIBLER F K RUSSELL Application Received: 7/17/2000 Permit Issued/Case closed: 9/1/2000 Case Finaled: 9/1/2000 mobile home installation 1.) The application was reviewed by Jefferson County Permit Center staff on 7/17/00 for the potential presence of critical areas regulated under the provisions of the Ordinance, and the following critical areas were confirmed as potentially present on the subject property: Eagles, Landslide Hazard Area, Susceptible Aquifer Recharge Area, and Shoreline (Conservancy). 2.) Acting upon the above information, Jefferson County staff conducted a site inspection of the subject property on 8/02/00 and confirmed the existence of the following critical areas and/or their associated buffers on the property: Eagles, Landslide Hazard Area, and Shoreline (Conservancy). 3.) The proposed temporary mobile home (medical hardship) is more than 1500-feet from the eagle nest site, therefore Shelly Ament from WDFW will require a 1-page eagle amendment to the applicant's existing plan. 4.) Aquifer recharge areas in Jefferson County are characterized by porous geologic formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 5.) Susceptible aquifer recharge areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. This includes any portion of Jefferson County with a DRASTIC index of greater than or equal to 180 points as determined using the U.S. Environmental Protection Agency DRASTIC methodology: Drastic: A Standardized System for Evaluating Ground Water Pollution Using Hydrogeologic Settings (EPA 600/23-87-035). 6.) These bluffs are considered unstable and are subject to catatrophic slides. The potential for an earthquake of a high magnitude occuring in western Washington in the near future is considered a high probability by regional experts. However, this proposal does not encroach upon the designated landslide hazard area. 7.) This waiver also includes findings and conditions for evaluation of shoreline areas as regulated under the provision of The Jefferson County Shoreline Management Master Program, adopted March 7, 1988, as amended. 8.) The standard setback for residential structures, including common appurtenant structures such as garages and workshops, shall be 30 feet, or 1 foot for each foot of bank height, whichever is greater. This setback shall be measured from the bank's edge when the bank height exceeds 10 feet. The temporary hardship unit is placed outside of the shoreline jurisdiction. 9.) Applicant shall fully and completely adhere to all the conditions and requirements of the eagle habitat management plan which have been agreed upon between the applicant and the Washington State Department of Fish and Wildlife. BLD00-00458 GIBLER F Application Received: 7/17/2000 Permit Issued/Case closed: 9/5/2000 Case Finaled: 9/28/2000 TEMPORARY FAMILY HARDSHIP No findings, conditions, or permissions found. FPA2607435 GIBLER F Application Received: 3/15/2006 Permit Issued/Case closed: 4/8/2006 Case Finaled: 4/11/2006 6 acre timber harvest No findings, conditions, or permissions found. SOM96-00343 GIBLER F Application Received: 2,'23/1998 Permit Issued/Case closed: Case Finaled: No findings, conditions, or permissions found. BLD98-00387 GIBLER S Application Received: 6/22/1998 Permit Issued/Case closed: 7/14/1998 Case Finaled: demolition No findings, conditions, or permissions found. BLD98-00388 GIBLER R Application Received: 6/22'1998 Permit Issued/Case closed: 7/14/1998 Case Finaled: single family residence No findings, conditions, or permissions found. CAR98-00174 GIBLER F S THEISS Application Received: 6/25/1998 Permit Issued/Case closed: 7/6/1998 Case Finaled: 7/6/1998 No findings, conditions, or permissions found. 1 of 2 Cases _ Name Review Type Status Planner PES 96-00343 GIBLERIKELLEHER F Application Received: 9/18/1996 Permit Issued/Case closed: 11/6/1996 Case Finaled: 2/23/1998 1.) AS PER WAC 246-272 ALL ALTERNATIVE SYSTEMS REQUIRE MONITORING. THIS MONITORING IS PROVIDED BY AGREEMENT BETWEEN THE JEFFERSON COUNTY ENVIRONMENTAL HEALTH DIVISION AND THE JEFFERSON COUNTY PUBLIC UTILITY DISTRICT#1. THIS SEWAGE DISPOSAL SYSTEM WILL REQUIRE AN ACTIVE MONITORING CONTRACT WITH THE PUD#1 PRIOR TO FINAL APPROVAL OF THE SEWAGE DISPOSAL SYSTEM. 2.) Health Dept. required to observe pressure test, 48 hour notice to be given. 3.) 100 ft. setback to all wells to be maintained 4.) 50 ft. setback from tanks to surface water to be maintained. 5.) MAXIMUM TRENCH DEPTH 9 INCHES 6.) Low use water fixtures required. 1.6 gal. flush toilets and 2.5 gpm shower heads when fixtures replaced. 7.) All components of the septic system are to be completely protected from vehicular traffic or mechanical disturbance. Protective barriers are required around drainfield. 8.) Drainlines are to be installed along the natural contours. 9.) Contact designer prior to installation for staking of drainfield area. 10.) Dose counters are required in the control panel for all drainfield components. 11.) Any portion of transport line under a driven way is to be double cased or equivalent. 12.) This community drainfield, serving more than one residence, will require a management and operations agreement with an entity approved by the Jefferson County Health Department as per Jefferson County Policy when/if the residences are separately owned or the property is subdivided. 13.) Asphaultic emulsion or equivalent required on septic tank and/or pump chamber. 14.) Approval/issuance of a sewage disposal permit does not guarantee the approval of other development or a building permit on this site. Compliance with other Jefferson County and Washington State Codes is required. 15.) Approval of this sewage disposal permit does not preclude the permit holder from complying with the Critical Areas Ordinance for other development on the site. XMP90-00032 GIBLERIKELLEHER E Application Received: 7/16/1990 Permit Issued/Case closed: 7/16/1990 Case Finaled: PROPOSAL: The proposal is to repair an existing pile bulkhead and an existing pile supported rail boat launch. No findings, conditions, or permissions found. 2 of 2 CASES, FINDING, CONDITIONS, PERMISSIONS FOR Parcel 901042006 Printed: September 13, 2010 Cases Name Review Type Status Planner SUB10-00018 MLA10-00344 GIBLER I P Application Received: 9/13/2010 Permit Issued/Case closed: Case Finaled: LAST WILL &TESTAMEN I ANY DIVISION No findings, conditions, or permissions found. 1 of 1 Parcel Print Page 1 of 1 Pared Number.901042006 05/14/2007 Owner Mailing Address: ELIZABETH BGIBLER 728 ADELMA BEACH RD PORT TOWNSEND WA 983689282 Site Address: Section: 4 School District: Port Townsend(50) Qtr Section: NW1/4 Fre Dist: Chimacum(1) Township: 29N Tax Status: Taxable Range: 1W Tax Code: 111 Planning area: Discovery Bay(5) Sub Division: Land Use Code: 9100 - VACANT LAND Property Description: S4 T29 R1W 1 TAX NO. 1 1 1 1 x No Photo Available http://www.co.jefferson.wa.us/assesso,s/parcellparcelprint.asp?PARCEL NO=901042006... 9/13/2010 Parcel Print Page 1 of 1 Parcel Number:901051003 05/14/2007 Owner Mailing Address: ELIZABETH BGIBLER 728 ADELMA BEACH RD PORT TOWNSEND WA 983689282 Site Address: 730 ADELMA BEACH RD PORT TOWNSEND 98368 Section: 5 School District: Port Townsend(50) Qtr Section: NE1/4 Fire Dist: Chimacum(1) Township: 29N Tax Status: Taxable Range: 1W Tax Code: 111 Planning area: Discovery Bay(5) Sub Division: Land Use Code: 1100 - HOUSES (single units, non-farm) Property Description: 55 T29 R1W I TAX 6(ENLGywBY TX 31),TAX RR-16 I TL TAX E 1 k . teliet:� 7 � iit. , 4.. 4" „, , N S E,9. i t,; -)23, e, http://www.co.j efferson.wa.us/assessors/parcel/parcelprint.asp?PARCEL_NO=901051003... 9/13/2010 D --1 m x fi 0 CT) -1 -I) x —I - CD co -- -- o) -0 cn 0) x a n r+ x 0) o -5 -o 0) o - -o -s -, o 0) < O. 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C), L O H 0 T z T D 6 C H m 4 f DEVELOPMENT REVIEW TIME SHEET ate Time Co ents •- -ID /Z 'i' o' bks oti`t o 15 rr.w, �in C27_ Lb ( lis vrl LoN UDC C I NSISTENCY REVIEW Project Pik er: Master#MLA10-00344 Review Type Pr.'ect Description (111 SUB10-00018 I L, ST WILL&TESTAMENTARY DIVISION tiii Ild Primary: ELIZABETH B GIBLER Site Address: 728 ADELMA BEACH RD ADELMA BEACH RD PORT TOWNSEND WA 9836892:2 PORT TOWNSEND WA, 98365 EDWARD MILBOURN REP 5251 S 200 E GREENFIELD IN 46140 CO QS) —go Project Location: Parcel number 901 051 00 &901 042 006, Section 5, Township 29, Range 1W, WM, located at 730 Adelma Beach Road, tort Townsend 98368 Parcel Number: 901042006 S-T-R: 4-29N-01W Total Acreaga 0 Legal Description S4 T29 R1W TAX O. 1 Land Use: 9100 Flood District: Fire District: 1 Planning Area: 5 Flood Map(FIRM)Panel No: School 50 Zoning: Parcel Number: 901051003 S-T-R: 5-29N-01W Total Acreag4 12 Legal Description S5 T29 R1W TAX i(ENLG BY TX 31),TAX RR-16 TL TAX Land Use: 1100 E Flood District: Fire District: 1 Planning Area: 5 Flood Map(FIRM)Panel No: l School 50 Zoning: COMP PLAN DESIGNATION: P . -, COMMUNITY PLAN: UGA: UGA Trans MPR: WATER SUPPLY UTILITY: Service Area OM V k_, A PUD: [ ] Plot plan states "property line" Assessor's Map(Property lines on submitt d plot plan must match the property lines as identified on the Assessor's 1/4 map) Legal Access to Prope 44/31 No " - Parcel Tags or Scanne. ..cuments C.NOy "' ESA's: Special Rqports Nearby YES 410 Designated Ag /6- .. , Shoreline Designation: ONO AA r 4 , V_ 4 Shoreline Slope S .. it : YES NO �'�i:� , / () , IV , / /) Stream Type :YES 4 Fish&Wildlife NO 1 Wetlands: YES ��. „ . Rare Plants:YES Seismic: op NO i �Landslide•4/„1 NO .3 Flood: YES t`om�+� i Erosion: YES ii0' Aquifer Recharge ' ea op 0 Si)SC_ jksj/i y .L. SIPZ: At ' isk High Risk (t,oas CMZ: none High Risk Mod- ate Risk Disconnected CMZ Stonnwa an subm. d: Y- Forest Lands: YES N0 Adjoining Forest Land . 4,,, Commercial/ Rural/ Inholding Stonnwater: New Impervious Surface ( i)----- _Land Disturbing Activity ,I ESA's Stomiwater Reqs: Min Req#2 Min Re.#1 thru#5 Min Req#1 thru#10 Engi g is Notice Provisions/Disclosure: Airport YES An 16):1RL YESForest ands YEs No i , Landscaping Required:Ye OVA? _OK Parking Spaces Required le 2 0 •r Building Height: 35' UBC Standard [ ] Impervious Surface coverage percentige: Resource Lands&Public: 10% Rural Residential: 25% Rural Industrial: Per UDC Sec 6.7 Rural Commercial: 60% Area of Building Coverage:60%in Rural Industr,a1 Lands only [ ] Total Building(s)Size: RVC:20,000 SF CC:5,000 SF NC:7,500 SF GC:10,000 SF All others:sut>jecttoseptic&water coastal rts/Norespecified [ ] Setbacks: Front: Left Side: Right Side: Rear: Shoreline Setback:_ LSHA Setback: _ [ ] Road Classification: Road Approach: EXISTING NOT EQ'D RAP [ ] SEPA Required: YES T [ ] Flood Certificate: [ ] Existing Case(s) &Condition(s): Violations: Yes No [ ] Recorded Date of Subdivision: AFN Over 5yrs=UDC Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance [ ] Lots/Require Declaration of Restrictive Covenant YES NO, submitted: YES NO [ ] UGA No Protest Agreement YES NO, submitted: YES NO [ ] Site Visit conducted YES NO [ ] Require Final Zoning Approval YES NO [ ] ADMIN: Setbacks entered in Permit Plan case N/A YES New Parcel Tags entered in Permit Plan N/A YES Special Reports Scanned N/A YES No parcel tags found for parcel Associated CASES status issued finaled description 901042006 MLA10-00344 SUB10-00018 P LAST WILL&TESTAMENTA'Y DIVISION