HomeMy WebLinkAboutDuckabush-Jefferson County - SHR Application - 2/8/2007 02/08/2007 16:31 N'Ai Guff .36Z `Jy13 L011N Live cue ntuKh wjvvl
o. /vu/ IV: VIAM IKAUIMAN MAHER & ASSOC,
No, 4109 P, 7
JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
g 621 Sheridan Street • Port Townsend Washington 98368
360/379-4450 • 360/379-4451 Fax
0 www.co.Jefferson.wa.us/commdevtelopment
Master Permit Application MLA:
Project Description (include separate sheets as necessary): -�
Hood Canal Steelhead Supplementation Project: Juvenile Monitoring
Tax Parcel Property -
Number: 502074022 size:
(acres/square feet)
Site Address and/or Directions to Property: 1585 DuCkabush Rd. Bannon, WA
Follow Co ote Rd. down to the river via a rivategated drive.
Property Owners)of Record: arty Ison, secretary Duckabush Community.
Telephone: 206-367-ad23 email,Mailing Address: 14034 36th St. NE, Seattle, WA, 98125.
Applicant/Agent(if different from owner): Long Live the Kin e _
Telephone:206-332.9555 Fax:
email:
Mailing Address: 1326 5th Ave,Ste,450.Seattle, WA, 98101.
What kind of Permit? (Check each box that applies)
C Ouilding ❑Variance(Minor, Major or Reasonable Economic Use)
O Demolition Permit O Conditional Use (C(a), C(d),or Cj"' I
❑Single Family 0 Discretionary"D"or Unnamed Use Classification
O Garage Attached/Detached D Special Use(Essential Public Facilities)
❑ Manufactured Home ❑ Boundary Line Adjustment
❑ Modular ❑Short Plat"
❑ Commercial" ❑Binding Site Plan
CJ Change of Use ❑ Long Plat"
❑ Address ❑Road Approach ❑Planned Rural Residential Development(PRRD)/Amendments"
❑Propane O Plat Vacation/Alteration
D Allowed"Yes"Use Consistency Analysis D Shoreline Master Program E_cemption/Permit Revisions
❑Stormwater Management E)Shoreline Management Substantial Development "
❑Site Plan Approval Advance Determination(SPAAD) ` ❑Shoreline Management Variance
❑Temporary Use O Comprehensive Plan/UDC/Land Use District Map Amendment
O Wireless Telecommunication' D Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Ralease of Six-Year Moratorium [J Tree Vegetaion Request
'May require a Pre-Appllcadon Conference "'Requires a Pre-Appllcallon Conference
Please identify any other local, state or federal permits required for this proposal, if known;
DESIGNATION OF AGENT
I hereby designate to act as my agerit in matters relating to this application for permit(s),
OWNER SIGNATURE Date.
y signing this application form,the owner/agent attests that the information provided herein,and In any attachments,is true and correct to the best o
his,her or it's 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 ail liabilities,judgments,court costs, reasonable attorneys fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree t s and right of entry to Jefferson County and its employees, representatives cr agents for the sale purpose of application
review and requirZlatin.pections. Staff access and right of entry will be assumed unless the applicant informs the County in writing at the
time of tt+e licalio s ants n 'ce Sev_f
Signature, 8 6
Date:
The action or a was Applicant will undertake as a result of the issuance of this permit may negative 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 Acr 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-tra feferabllo responsibility for pdhenng to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature " J V v`•d �v'� �(' G{�/l h f Cye c. r3 I r- L" rk-e- Date _ � - �- U -)
CADric-wments and ScuingA aral\Local Setdngi\Temporuy tntcmut l Jos\011(B6\Mower Pormil Applicario)12-19-2(M1G.dnc