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4 <br /> National Pollutant Discharge Elimination System (NPDES) Phase II <br /> Storm Water Permit Application, Washington Department of Ecology <br /> Phase II Municipal Separate Storm Sewer Systems (MS4s) <br /> The purpose of this application is for a local government or special district to apply for an NPDES permit to <br /> discharge storm water runoff from a Phase II municipal separate storm sewer system. The Department of <br /> Ecology may request additional information and a notice of intent when a general permit is adopted. <br /> MS4s seeking coverage must complete and return this application based upon existing information to the <br /> Department of Ecology before March 10, 2003. You may print this form and complete it by hand, or complete <br /> and submit it electronically. This is a Microsoft Word 2000 document. <br /> Mail completed application to: Department of Ecology, PO Box 47600, Olympia, WA 98504. Ecology will <br /> send you an acknowledgment of receipt. If you have questions about this application, please contact Janice <br /> Sedlak, (360) 407-6470,jsed461@ecy.wa.gov. <br /> Part I. General Information <br /> 1., f MS4 Operator., <br /> Name of city,county,special district,or other public entity: City of Everett <br /> Street Address: 3200 Cedar St <br /> City,State,Zip: Everett,Wash 98201 <br /> Ownership status ❑ Federal ❑ State ❑Private,. ® Public ElOther Entity <br /> 2 Lroca staff contact(``erson es onsible for ro ram un lementation and oordmaio�)„ 3 Via- ' <br /> Name: Dan Mathias Phone: (425)257-8855 <br /> Title: Principal Engineer E-mail: dmathias@ci.everett.wa.us <br /> Y1. 'a" s�,.�Y"„-,& 4 �y,1FyF`.,' f `�f.y f TA�a...5'Y...c ?°`' y,. ; . ,:i i' 'yt�"'' r y'A ! * Y,, a xr.q <br /> o xratf♦ n ,� 'tisYATR r} + _Fit #5. - , i- y'+ j ?• A q C A.. '9, �,6g.} r x,.'. <br /> ` + 7�Y.- .frn �:+ !ri*f.b4'::. .1.. 'il:.:�+rr'x. �1i �E. ••_S"rY,3a,r .sir ,.,,..f:::. ..a 3s7�±,r <br /> ® City ❑ Town 0 Drainage District <br /> ❑ County D flood Control District ❑ Other(list): <br /> .� y vi iii <br />