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APPLICATION FOR COVERAGE <br /> MOSQUITO CONTROL GENERAL PERMIT <br /> NOTICE OF INTENT <br /> TO COMPLY WITH THE TERMS OF THE STATEWIDE GENERAL NATIONAL <br /> POLLUTANT DISCHARGE ELIMINATION SYSTEM(NPDES)PERMIT FOR <br /> DISCHARGES OF AQUATIC PESTICIDES TO CONTROL MOSQUITO LARVAE AND PUPAE TO SURFACE WATERS OF <br /> THE STATE(GENERAL PERMIT) <br /> 0 Change of Information Only <br /> Permit#WAG-99-2 <br /> WASHINGTON STATE USE ONLY: <br /> Permit Number Ecology Region W.R.I.A. Date Received Coverage Date <br /> ❑ ❑ <br /> I. PERMITTEES: <br /> MCD/Business Name <br /> City of Everett Public Works <br /> II. MAILING AND CONTACT INFORMATION: <br /> Contact Name <br /> Dan Mathias <br /> Mailing Address <br /> 3200 Cedar St <br /> City State Zip+4 <br /> Everett WA 98201 <br /> E-Mail Address Daytime Phone No. <br /> DMathias@ci.everett.wa.us (425) 257-8855 <br /> Cell Phone No. <br /> Lead Operator/Applicator Name <br /> III. PERMIT BILLING ADDRESS INFORMATION: <br /> Contact Person <br /> Marilou Moore <br /> Mailing Address Phone No. <br /> 3200 Cedar St (425) 257-8962 <br /> City State Zip+4 <br /> Everett WA 98201 <br /> IV. APPLICATION TYPE: <br /> ® New Permit <br /> O Existing Discharger Or <br /> O New Discharger <br /> ❑ Permit Coverage Modification Permit No. WAG- - <br /> Reason for modification: <br /> *If you have checked Existing Discharger section V does not apply,please proceed to section VI. <br /> *If you have checked New Discharger or Permit Coverage Modification,section V must be completed. <br /> Application for Coverage <br /> 8/6/99 <br /> 8 <br /> O <br />