Wash. Admin. Code § 173-27-990
Appendix A
Shoreline Management Act
Permit Data Sheet and Transmittal Letter
From: | (local government) | To: | (appropriate Ecology office) | ||||
Date of Transmittal: | Date of Receipt: | (provided by Ecology) | |||||
Type of Permit: (Indicate all that apply) | |||||||
Substantial Development ; Conditional Use ; Variance ; Revision ; Other . | |||||||
Local Government Decision: Approval ; Conditional Approval ; Denial : | |||||||
Applicant Information: | Applicant's Representative: (if primary contact) | ||||||
Name: | Name: | ||||||
Address: | Address: | ||||||
Phone(s): | Phone(s): | ||||||
Is the applicant the property owner? yes no | |||||||
Location of the Property: (Section Township and Range to the nearest 1/4, 1/4 Section or latitude and longitude, and a street address where available) | |||||||
Water Body Name: | |||||||
Shoreline of Statewide Significance: Yes No . | |||||||
Environment Designation: | |||||||
Description of the Project: (Summary of the intended use or project purpose) | |||||||
Notice of Application Date: | Final Decision Date: | ||||||
By: | (Local Government Primary Contact on this Application) | ||||||
Phone No: | |||||||
Wash. Admin. Code § 173-27-990
Statutory Authority: RCW 90.58.140(3) and [90.58].200. 96-20-075 (Order 95-17), § 173-27-990, filed 9/30/96, effective 10/31/96.