HomeMy WebLinkAbout00A Road Naming Petition¢SON �, DEPARTMENT OF COMMUNITY DEVELO I.-_ .
��i� 621 Sheridan Street, Port Townsend, WA 98368 � L� Ce �Vl 1
ti
Tel: 360,379.4450 Fax: 360.379.4451
Web: tyW1Ml"�rsvrrx+n.irs/canrmuni deve prrient ti
E-mail: �tcdCunco.iefirersan.wa.us
` 1 F F E3 2 2 2022
1 N �'S PPLEME U NTAL APPLICATION -
ROAD NAME PETITION
How to Name your Road:
1. Pick three road names that have no more than fifteen (15) characters (including spaces, excluding road type).
2. Submit: 1) complete Road Name Petition; 2a) fee for the petitioner of $432.60 for a new road name, $738.15 for
road name change; 2b) $115 for each additional parcel to be addressed (parcels with currently assigned
addresses will not be charged to be readdressed as part of the road naming process); 3) a map of the area, that
indicates proposed road and all driveways off of the road; and 4) complete New Address Application.
The cost of one red address plate is included with the price of the road -naming fee. Additional plates are $20 each.
Petitioner Contact Information
Applicant (Print full name):
A, /►'l �C-_ M vL v1 V1
Mailing Address:,,
City: ' !7 State: ZIP Co e:
Parcel Number:
Telephone Number: 'j 0 ^ 3_ 0
Email: ) I /V, P M (A to vt pk"S , itp
Red address plate to be: Apickedup D mailed
Describe the beginning an end of the road to be named (e.g
length in miles fro�ml Ia ,b1e�ginnin point).
��tL
Proposed Road Names
List three unique road names (Maple Lane and Maple
Way are not unique road names because the road name
is the same, and only the road name type changed), and
the preferred road type, in order of preference. The
County will ultimately determine road type (lane, road,
court, etc.). Applicant's 3 proposed names should follow
criteria listed on back of this form. County will consider
road name in order of preference, below.
First Choice B LAI ST_6:__�
Second Choice 9 LU�C SI-A R
Third Choice
intersection with another named s reet, end of street,
For Road Name Changes
Complete this section if this is a request for a road name change. A request for re -naming a private road will require the
approval of 75% of the property owners adjoining the road. In the event 75% approval is not obtained, the private road
will not be renamed. The fee for a road name change is $738.15.
Existing road name to be changed:
We, the following property owners that are or will be accessing the road to be named, have reviewed the proposed
names and agree with the choices. We understand that when the road is named our addresses will change. We
understand that if the private road sign at the entrance of the road is stolen or destroyed, it will be the shared
responsibility of all property owners to replace and maintain the sign.
Parcel Number I Name I Sionature
All structures obtaining access off the newly named private road will be issued a physical address according to milepost
location. Any existing addresses will be updated according to the new road's measurement. Road signs are the
responsibility of the applicant.
The Department of Community Development reviews the petition to determine the sufficiency of the petition, acceptability
of the proposed road names, and that all necessary information is included. Notification of final approval of the road name
will be sent to the property owners, appropriate County offices, the Post Office, Fire District, and JeffCom (911).
WE, THE UNDERSIGNED, property owners addressed along the road, in accordance with JCC 12.20, do hereby petition
Jefferson County to NAME A ROAD. We understand that by signing this petition, we are agreeing to allow the County
personnel egress to the private road to assign new address numbers.
Signature Date
o
} � o
O f*1
.,�.
Cld O 1 N.,✓y \
r'ea
Clh
702223p13 1p
LLO £ZZZOL 0
r
oLo£zZZOL i 702223a12 0 8�
N
un
r N
O N m I CN
rY +4+4
N O NO T O I
N O N I
N n
O N N
N • O,
C I I
J 702272O2Q
Ln —T
N
0
N
C)
ti
kb'
�s
a,
(gn,
o�
N
0
5'
o iX
0
N
.Y
h
• N
tiV 3
o•
e
i
enw
N
I-O
N
N
O
B�0
co
O
^
'L CD
1'�
O
O
O
^ `��
N
N
N
O
CDO
O
O
M
N
r
NN
N
N
---' ---1-- - - --r4
CD
j t'I.OZLZi
I 1
ti
N
O N
N O
N (~(yy
O iy
O
P-
.A i
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street, Port Townsend, WA 98368
Tel: 360.379.4450 1 Fax: 360.379.4451---
Web: www.cn' fF rst us o uni . ! ❑ en `i ! L C 4 U
E-mail: dcd@co.jeffcrson.wa,jis I I'
F E H 2 2 2022
NEW ADDRESS APPLICATION i
Steps in the Permit Process: �•, ,.. �A,i,��` r
1. Fill out application J
2. Submit application, Site Plan, and fees
a. Your application may be submitted to the email address above, by mail, or by dropping it in the
dropbox outside of our office located at the address above. Emailed applications are the preferred
method of receipt.
b. Fees may be submitted as indicated on page 2 of this application.
c. Additional fees may apply after review; payment is required before permit is issued.
d. Review may trigger your road to be named. For more details about this process, please visit this link:
htt ://www.co.iefferson.Wa.US/FAQ.as x? ID-561..
3. Flagging tape maybe sent to you if the entrance to your driveway is unclear
4. Address is assigned, agencies are notified, and red address plate is given to person indicated on the application
For Department Use Only
Related Application #s:
✓ New driveway must be
FOR OFFICE USE ONLY
Tidemark Entry:
New Address:
Road Naming? ❑ Yes O No
New Address
Assessor Tax Parcel Number:
with
Receipt #:
Payment M
received from DCD.
DIFF LEFT M.P. RIGHT DIFF Notes
Road database entry:
MLA #
Post Office:
Date plates req'd from PW:
0 Address Correction
Z - 2Z3 - oaf
Parcel Address (if applicable):
Directions to Property: )+W V /a / - -Fi g �l•
2000-" -tv valve W
Name of street(s) from which access will be gained:
Is this a private road? ef Yes C
Date:
# Plates:
0 Change of Address
City a Lx t t c-eo-e
K,i
�( rl Cross Street k YA fc, k -e
P-aq4
If your driveway is off of a state highway or public road you will need a state highway Access Permit or Road
Approach permit.* If you answered "no" to the question above, please list your County or State Permit #.
County or State Permit #: /--
*ROAD APPROACH OR STATE HWY ACCESS PERMITS ARE REQUIRED IF YOUR DRIVEWAY IS OFF A COUNTY OR STATE ROAD IN
ORDER TO PROCESS ADDRESS REQUEST. Please contact Public Works at (360) 385-9160 with questions.
• State: WSDOT https://www.wsdot.wa.gov/Design/DevelopmentServices/AccessPermitGuidelines.htm or
(360) 757-5961
■ County: https://wa-jeffersoncounty.civicplus.com/445/Right-of-Way-Permits-Vacations or (3E0) 385-9160
Property Owner
Name: TAME S_A4 u (a n _ --
Address: F0 . S{ City, State ZIP: 062 11 C e- U/A q,6376
Phone #: (-L4 7 oo E-mail Address:
_ 211 09- A/..Ld.V1 Vt CO M
❑Please direct all project inquiries to the alternate contact listed below.
Alternate Contact
Choose One: OApplicant 0 Contractor 0 Authorized Agent 0 Representative
Name:
Address: City, State ZIP:
Phone #: E-mail Address:
Address Plate Receipt _
I prefer to:
Pick up my address plate
(we will email you with pick-up
instructions when the address plate is
ready to be picked up)
( Have my address plate mailed to
the person listed in the column to
the right
Mail plate to:
Property Owner
Address
Alternate Contact
0 Other
(list Other mailing address in
the column to the right)
Submittal Items — use column on left to check off items included with
Other mailing address:
submittal
17 Si Plan, showing: f
a. Parcel driveway location, label any driveways as new or existing, jf
ND 5qu,0R.,�,Trave I path from driveway, then the structure;
No N t, c. if there are multiple structures, the addresses of all existing structures;
"A d. For commercial permits, identify suite numbers for all existing and proposed businesses and identify
the business names.
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 making any issued permit null and void.
I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in compliance
with all applicable federal, state and county laws and regulations and I 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.
Applicant may request notice of the County's intent to enter upon the property for visits related to this application and subsequent
permit issuance.
VL/L
Signature: Print Name: -_�1 �� I �� u Date:
Jefferson County will notify the appropriate postmaster, fire district, and emergency services of your new address. We will
provide you with a new fire plate and you will be required to install it as directed once the address is assigned.
Permit Fees
Pay fees online using our payment portal located at. htt s: www.co. e erson.wa.us 6I Z Credit-Card•E-Check-Payments- or-
Permits.by submitting a check by mail or by dropping it in the dropbox outside of our office located at 62.1 Sheridan Street.
New Address Permit Fee DCDO12
Tech Fee DCDO03
TOTAL
*Additional fees may apply.
$306.00*
15.30
$321.30
Additional address plates may be requested and are $20 each.