625 RIVERSIDE RD SEPA 016 - 028 - FREIGHT HANDLING FACILITY Land Use Decision Documents 2025-04-21

Part 11—Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. hel 11 a. Applicant Signature (required)[help] I certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurate. I also certify that I have the authority to carry out the proposed activities, and I agree to start work only after I have received all necessary permits. I hereby authorize the agent named in Part 3 of this application to act on my behalf in matters related to this application. mfa (initial) By initialing here, I state that I have the authority to grant access to the property. I also give my consent to the permitting agencies entering the property where the project is located to inspect the project site or any work related to the project. mfa (initial) Michael G. Fa Michael Fa Digitally signed by Michael Fa Date: 2016.08.30 20:51:49-04'00' Applicant Printed Name Applicant Signature 11 b. Authorized Agent Signature[help August 30, 2016 Date I certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurate. I also certify that I have the authority to carry out the proposed activities and I agree to start work only after all necessary permits have been issued. Authorized Agent Printed Name Authorized Agent Signature 11c. Property Owner Signature (if not applicant) hf eM Not required if project is on existing rights -of -way or easements. Date I consent to the permitting agencies entering the property where the project is located to inspect the project site or any work. These inspections shall occur at reasonable times and, if practical, with prior notice to the landowner. �IOK 1�/ Prop rty Owner Printed Name Pro a Own r Signature Date ,�v ✓ �� V V l C i�Gt tiliejCv 18 U.S.0 §1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States knowingly falsifies, conceals, or covers up by any trick, scheme, or device a material fact or makes any false, fictitious, or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false, fictitious, or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than 5 years or both. If you require this document in another format, contact the Governor's Office for Regulatory Innovation and Assistance (ORIA) at (800) 917-0043. People with hearing loss can call 711 for Washington Relay Service. People with a speech disability can call (877) 833-6341. ORIA publication number: ENV-019-09 rev. 09/2015 JARPA Revision 2015.1 Page 16 of 16