HomeMy WebLinkAbout00B Addressing ApplicationsDEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street, Port Townsend, WA 98368 - --
Tel: 360.379.4450 1 Fax: 360.379.4451
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MAR - 3 2022
NEW ADDRESS APPLICATION
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Steps in the Permit Process: -- - -----_-•-----
1. Fill out application
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:
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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
FOR OFFICE USE ONLY
Tidemark Entry:
New Address:
Road Naming?
must be flaed with
Receipt # Date:
Payment #:
received from DCD.
DIFF LEFT M.P. RIGHT DIFF Notes
Road database entry:
O Yes O No MLA #
New Address
Information
Assessor Tax Parcel Number:
Parcel Address (if applicable):
Directions to Property:
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Name of street(s) from which
Is this a private road?
13232004
Post Office:
Date plates req'd from PW
Address Correction
# Plates.
0 Change of Address
City Fprkb
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Or Yes 0 No
Cross Street
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 (360) 385-9160
Property Owner
Name:
Address:
Phone #:
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MD _44D .,&0 E-mail Address:
Please direct all project inquiries to the alternate contact Iisted below.
Alternate Contact
Choose One: 0Applicant 0 Contractor oAuthorized Agento Representative
Name:
Address: Shp.ke Q . /?,D. ?max 2452. City, State ZIP
Phone #: VPD - 4qj - D5E* E-mail Address: rnM
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Address Plate Receipt
I prefer to:
Mail plate to:
Other mailing address:
Pick up my address plate
Property Owner
.vifl
Address
Alternate Contact
'Have'm`y'addres's plate mailed to
Other
the person listed in the column to
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the right
I Required Submittal Items — use column on left to check off items included with your submittal_
Site Plan, showing:
a. Parcel driveway location, label any driveways as new or existing;
b. Travel path from driveway, then the structure;
c. If there are multiple structures, the addresses of all existing structures;
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.
Signature: Print Name: oA m Vel! I ,e, 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. a erson.wo.us 6.t7 C►edit-Card-E-Check-Pa ments- or-
reitrr,c_,by submitting a check by mail, or by dropping it in the dropbox outside of our office located at 621 Sheridan Street.
New Address Permit Fee $306.00*
Tech Fee P,*. 15.30
TOTAL $321.30
*Additional fees may apply. Additional address plates may be requested and are $20 each.
Public Land Records
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Page 1 of 1
Step 3: Confirmation and Receipt
Result: Payment Authorized
Confirmation Number: 109926809
Your payment has been authorized successfully and payment will be processed.
Jefferson County Department of Community Development thanks you for your payment. For questions about your account, please call 360-379-4452 Thank you for using
our bill payment services.
Please save or print a copy of this receipt for record keeping purposes.
My Bills
of $321.30 on Parcel Number Or Address 613232004
Customer Information
First Name:
Susan
Last Name:
Vella
Address Line 1:
240 W 5th Street
Address Line 2:
240 W 5th Street
City:
Port Angeles
State:
Washington
Zip Code:
98362
Phone Number:
360-460-7638
Email Address:
suz359@hotmail.com
Payment Information
Payment Date: 02/28/2022
Card Type: Visa
Card Number: *****'***'**0820
$321.30
Subtotal: $321.30
Convenience Fee: $10.00
Total Payment: $331.30
Susan Grantham
From: Susan Grantham
Sent: Thursday, March 3, 2022 12:09 PM
To: Imaggielparks@hotmail.com'
Subject: new address application for Velie, parcel 613232004
Dan Boyd:
We have received your application and payment for a new address for the owners of the above parcel. The driveway is
located 1,700 feet from G&L Shake Rd, and is thus too far from G&L Shake Rd to be considered a driveway. This parcel is
also the 4th to be addressed along said driveway, which means that now the drive is considered a road. The Velies will
need to procure a road naming permit. All parcels along that drive will be re -addressed with the new street and house
number. You will also need to provide us with proof of easement for accessing the Velie parcel via adjacent parcels
613232003 and 613232006. A link to the Road Name Petition is below.
&tps:llwww.co.Jefferson.wa.u-s Search?searchPhrase-road%,20namin�
The Road Name Petition and instructions on how to name a road are listed on that page. The $321.30 that the Velies
paid for their new address will be applied to the road naming petition. Their address application will be held in abeyance
until such time as the road naming petition has been finalized.
If you have any questions, do not hesitate to contact us.
Susan Grantham
Community Development Tech I
Jefferson County Community Development
621 Sheridan St., Port Townsend, 'WA 98368
Won-7hurs 9am - 4:30pm, closedf om 12-1
Tfi: 360-379-4450
htt : w.co. a erson.wa.us
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