WAC 173-27-990. Appendix A

Appendix A Shoreline Management Act Permit Data Sheet and Transmittal Letter From: (local government) To: (appropriate Ecology office) Date of Transmittal: Date of Receipt: (provided by Ecology) Type of Permit: (Indicate all that apply) Substantial Development ; Conditional Use ; Variance ; Revision ; Other . Local Government Decision : Approval ; Conditional Approval ; Denial : Applicant Information: Applicant's Representative: (if primary contact) Name: Name: Address: Address: Phone(s): Phone(s): Is the applicant the property owner? yes no Location of the Property : (Section Township and Range to the nearest 1/4, 1/4 Section or latitude and longitude, and a street address where available) Water Body Name: Shoreline of Statewide Significance: Yes No . Environment Designation: Description of the Project: (Summary of the intended use or project purpose) Notice of Application Date: Final Decision Date: By: (Local Government Primary Contact on this Application) Phone No: From: (local government) To: (appropriate Ecology office) Date of Transmittal: Date of Receipt: (provided by Ecology) Type of Permit: (Indicate all that apply) Substantial Development ; Conditional Use ; Variance ; Revision ; Other . Local Government Decision : Approval ; Conditional Approval ; Denial : Applicant Information: Applicant's Representative: (if primary contact) Name: Name: Address: Address: Phone(s): Phone(s): Is the applicant the property owner? yes no Location of the Property : (Section Township and Range to the nearest 1/4, 1/4 Section or latitude and longitude, and a street address where available) Water Body Name: Shoreline of Statewide Significance: Yes No . Environment Designation: Description of the Project: (Summary of the intended use or project purpose) Notice of Application Date: Final Decision Date: By: (Local Government Primary Contact on this Application) Phone No: