121 E MARINE VIEW DR 2016-01-01 MF Import

- •bPPLcants who discharge swrmaacer auaiated a9th coasmicrion activity m a storm drain opera�ed by any of tbc following municipalidcs shall also submit a copy of tLe NOI to the m�micipaliry: SeaWe, King Counq•, Snohomish Coimry, Tawma, Pfcrce Coimn•, Ciark Coimry, SpoFane Co�mry, V✓ashingcon Deparmienc ot TransPonarion. Fees 7bere is no applicarion fce. You will be pilled tor pctmit frs aher tht permit i�issvcd. Call (360) 407-642$ for qu:stioas reladng [o fees. LINE-BY•LINE INSTRUCTIONS FOR COMPLETING THE N01 Completing the NOt; Notificetion of Coverage ;Lc N01 is an official document commitring thc p�rmi�e [o compliance with the rcquiremenu of th: General Pcrmic. I� should be completcd accuracely, complc[ely and legibly. P/ease print in ink o� rype. Change of Intorma6on: ChccL-this boz J info�mation intludtd 'm a previoatly submined NOI application in which permic covcrage aas giantcd Lu changed. An exam�le of a cLange could bc a ncw concict peraon, billing address, or total azea to be distnrbed. [nclude vour zc9mcd permit nump�� m ��T rieht hand comer of the NOI Yoar asri�ed permic aumber is in the upp�r nght hand corner of the first(atle)page of your permi[. Complete only tbou ucdons of thc N01 tha� rcquire changes. Please submit a aaamiiQal leaer which confimu/exp];i�s tt�e �ge of informauon in the NOI. Permit Number: Uu only if you aze r:poning a •(�a¢�e of Informarian" ° r, � Section I - Contact Person � Give the nam;, address, and [elephone number of th: perspn a�ho i5 avai]able ?A hours a day to respond �o emergencics, and ?� w inquiri�s or directives from Ecology. 'Ibe conuct}r.rson should be someone a�ho is completely familiar aith the si�e, and chuged aith werseeing compliance ^„i� �h:permit rcquiremenu. This person could be an emplo3'ee, a coanilcanc, a developer, or a coutractor. Section II - OwnerlRepreseMative of She Givc th: name, address and the telephone number of�person, compaaY. firm. public co[poraaon. municipaliry or any other enrity a�hich pw�or legallY rcprcsents thc a�. u�pe owner is the sacue az tLe conmct petson, enttr "samc at cootacc p:cson" on the first line. 7Le permit and all other coaespondence will be sent�o this address. An euepuon to th:s informauon is fhe bi]ling addn.a. Section III - Site Address Enter the saa[address or locadoa dcscripdon (eg. Intersection of B & C svcca, also include the co�mty) for the �aasw�tion site• Construcdon ates ahich do not have a street addras mutt also provide a legal descripdon of the location eithu in the space provided or by an amchment. Section IV • Billing Address Indica�e a�hcce the annuyl and fina]permit fee invoices should be sent. qlso pro��de a conqct person wLo can answer any 4uestians on the billing invoices. < Section V • Receiving Water Irtformation ln Part A, check the approptiatt bous for receiving Kat�r infotmation for the stormwater discharges hom the consvuction site. In Part A.I - Check this boz if stormwatcr Iwving your ate en[ers a storm drain s}stem, and indicate the name of the owner of the s�orm drain sy�tem: such az a municipality, poocl control disuic[, ualiry or private entiry(e.g. ��y�pazk) . In Part A2 -Cqeck this boz if stormwakr ilows directly or indirecUy mto or wer adjacrnt properries, throug6 ditches or right-of-ways to surface aaters of tLe State; th: definidpo of a svcface aater includes iakes, rivers, � aattrs, and ntUandc. P��. meams, salt � In Part A3 -Check this boz if stormcr�ter hom yonr a[e is dischazged to thc gound. lndica[e by what method by checking one of the three cLoices. If you dischaig� �p��r�� o� �are aot reqaired eo app�y for cwerage nnder ISe general permit. In Part B, indiwte the name of th^. firsc doavsrream rec:iving water(s) ahicL Las an asvpAed namc. If stormwater is discLazged to more � �e recciving watcr, the names of each receiving water must be listed. Indicate wh��er the � � �