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Application 51717 Certification <br /> Id: Received: <br /> (Ecology use) <br /> Facility/Site Eclipse Mill Park Permit <br /> Name: Number: <br /> (Ecology use) <br /> Facility The Project would occur at the Eclipse Mill Park site, Facility Snohomish <br /> Address: located at 3535 Riverfront Drive. The site is located on the County: <br /> west bank of the Snohomish River immediately adjacent <br /> to and northeast of the intersection of 36th Street and <br /> Riverfront Boulevard. <br /> Permittee Katherine Phillips Permittee Capital Projects <br /> Name: Title: Coordinator <br /> Permittee kphillips@everettwa.gov Permittee 4256260217 <br /> Email: Phone: <br /> Permittee 802 E Mukilteo Blvd Company City of Everett <br /> Address: Everett, WA 98203-2100 Name: <br /> Disturbed 1.25 <br /> Acreage: <br /> Certification of Permittee <br /> "I certify under penalty of law that this document and all attachments were prepared under my direction or <br /> supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate <br /> the information submitted. Based on my inquiry of the person or persons who manage the system or those <br /> directly responsible for gathering the information, the information submitted is, to the best of my knowledge and <br /> belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false <br /> information, including the possibility of fine and imprisonment for knowing violations." <br /> Cassie Franklin City of Everett Mayor <br /> Printed Name I C pany Title <br /> - /00,96 <br /> ature of P ee * Date <br /> * Federal regulations require this application is signed by one of the following: <br /> A. For a corporation: By a responsible corporate officer, of at least the level of vice president. <br /> B. For a partnership or sole proprietorship: By a general partner or the proprietor, respectively. <br /> C. For a municipality, state,federal, or other public facility: By either a principal executive officer or ranking elected official. <br /> Please print, sign and mail this form to the following address: <br /> Department of Ecology <br /> ATTN: Water Quality Program, Construction Stormwater P.O. Box 47696 <br /> Olympia, WA 98504-7696 <br /> Office of the City Attorney <br /> APPROVED AS TO FORM ATT <br /> 'T• <br /> David C.Hall,City Attorney 11 <br /> • <br /> er{ <br />