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Home My WebLink AboutSHX2023-00037 Bulkhead - SHX Application - 9/21/2023 -��2.�Id 2�a23• o 113� —T E ON�tt Date Receive USE Corps WASHINGTON STATE tEP 21 2023 SWM dEnglt Joint Aquatic Resources Permit AgencyGelf&3 .#AL•4��•• h t"QQ7�� Application (JARPA) Form 1'2 h[ elpl Tax Parcel#(s): `�aL'�,3-50 ooco o. USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW. .................................................................................................................................. Part 1 - Project Identification 1. Project Name (A name for your project that you create. Examples: Smith's Dock or Seabrook Lane Development) h[ elpl Nye Tides LLC Bulkhead Replacement Part 2 - Applicant The person and/or organization responsible for the project. h[ elpl 2a. Name (Last, First, Middle) Kramer, Wendy 2b. Organization (if applicable) Nye Tides, LLC 2c. Mailing Address (Street or PO Box) 6249 Old Olympic Hwy SW 2d. City, State, Zip Olympia, WA 98512 2e. Phone (1) 2f. Phone (2) 2g. Fax 2h. E-mail ( 360 ) 339-3039 ( ) ( ) wdnkramer@hotmail.com 'Additional forms may be required for the following permits: If your project may qualify for Department of the Army authorization through a Regional General Permit(RGP),contact the U.S.Army Corps of Engineers for application information(206)764-3495. • If your project might affect species listed under the Endangered Species Act,you will need to fill out a Specific Project Information Form(SPIF)or prepare a Biological Evaluation. Forms can be found at http://www.nws.usace.army.mil/Missions/Civil Works/Regulatory/PermitGuidebook/EndangeredSoecies.aspx. • Not all cities and counties accept the JARPA for their local Shoreline permits.If you need a Shoreline permit,contact the appropriate city or county government to make sure they accept the JARPA. 'To access an online JARPA form wth[help]screens,go to http://www.epermitting.wa.gov/site/alias resourcecenter(arpa iaroa form/9984fiarpa form.aspx. For other help,contact the Governor's Office for Regulatory Innovation and Assistance at(800)917-0043 or help(CDorla.Wa.goy. ORIA-revised 02/2020 Page 1 of 15 Part 3 - Authorized Agent or Contact Person authorized to represent the applicant about the project. (Note: Authorized agent(s) must sign 11 b of this application.) 1heI 3a. Name (Last, First, Middle) Rotsten, Jennifer 3b. Organization (if applicable) Sealevel Bulkhead Builders, Inc. 3c. Mailing Address(Street or PO Box) PO Box 375 3d. City, State, Zip Kingston, WA 98346-0375 3e. Phone (1) 3f. Phone (2) 3g. Fax 3h. E-mail ( 360 ) 297-2401 ( 360 ) 710-0899 ( 360 ) 297-2308 Jenny@sealevelbb.com Part 4 - Property Owner(s) Contact information for people or organizations owning the property(ies) where the project will occur. Consider both upland and aquatic ownership because the upland owners may not own the adjacent aquatic land. Ltfjp1 ® Same as applicant. (Skip to Part 5.) ❑ Repair or maintenance activities on existing rights-of-way easements. (Skip to Part 5.) ❑ There are multiple upland property owners. Complete the section below and fill out JARPA Attachment A for each additional property owner. ❑ Your project is on Department of Natural Resources (DNR)-managed aquatic lands. If you don't know, contact the DNR at (360) 902-1100 to determine aquatic land ownership. If yes, complete JARPA Attachment E to apply for the Aquatic Use Authorization. 4a. Name (Last, First, Middle) Kramer, Wendy 4b. Organization (if applicable) Nye Tides, LLC 4c. Mailing Address (Street or PO Box) 6249 Old Olympic Hwy SW 4d. City, State, Zip Olympia, WA 98512 4e. Phone (1) 4f. Phone (2) 4g. Fax 4h. E-mail ( 360 ) 339-3039 ( ) ( ) wdnkramer(a)hotmail.com ORIA-revised 02/2020 Page 2 of 15 Part 5 - Project Location(s) Identifying information about the property or properties where the project will occur. heI ❑ There are multiple project locations (e.g. linear projects). Complete the section below and use JARPA Attachment B for each additional project location. 5a. Indicate the type of ownership of the property. (Check all that apply.) h( e ® Private ❑ Federal ❑ Publicly owned (state, county, city,special districts like schools, ports, etc.) ❑ Tribal ❑ Department of Natural Resources (DNR) - managed aquatic lands (Complete JARPA Attachment E) 5b. Street Address (Cannot be a PO Box. If there is no address, provide other location information in 5p.)[he 23022 North Shore Hwy 101, 5c. City, State, Zip (If the project is not in a city or town, provide the name of the nearest city or town.) heI Hoodsport, WA 98584 5d. County hf el Mason 5e. Provide the section, township, and range for the project location. hf elpl 1/4 Section Section Township Range 23 22 N 04 W 5f. Provide the latitude and longitude of the project location. Jhel • Example:47.03922 N lat./-122.89142 long.(Use decimal degrees-NAD 83) 47.386/-122.146 5g. List the tax parcel number(s) for the project location. h� el • The local county assessor's office can provide this information. 42223-50-00006 5h. Contact information for all adjoining property owners. (If you need more space, use JARPA Attachment C.) hel Name Mailing Address Tax Parcel #(if known) MaryJane and Steven 22023 N Hwy 101 422235000009 Gambriell ........................................................................................................................................................... Shelton, WA 98584 Sheldon Prop PO Box 474 422231100060 ........................................................................................................................................................... Hoodsport, WA 985480474 ........................................................................................................................................................... ORIA-revised 02/2020 Page 3 of 15 5i. List all wetlands on or adjacent to the project location. h N/A 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. hf pl Hood Canal 5k. Is any part of the project area within a 100-year floodplain? hf pl ❑ Yes ❑ No ® Don't know 51. Briefly describe the vegetation and habitat conditions on the property. heI Lawn and trees 5m. Describe how the property is currently used. hf elpl SFR 5n. Describe how the adjacent properties are currently used. hei SFR 5o. Describe the structures (above and below ground) on the property, including their purpose(s) and current condition. of L-- l Owner's home and existing concrete bulkhead 5p. Provide driving directions from the closest highway to the project location, and attach a map. Ltgipl Heading south on Hwy 101 toward Potlatch and end at site on left ORIA-revised 02/2020 Page 4 of 15 Part 6 - Project Description 6a. Briefly summarize the overall project. You can provide more detail in 6b. hf eij After the fact permit for emergency work completed: Recently, portions of the existing bulkhead have shifted and there are signs of fill loss on the landward side, suggesting failure may be imminent. A pre-cast concrete soldier pile bulkhead will be installed landward of the existing concrete bulkhead and then the old concrete bulkhead will be removed. All pilings waterward of the bulkhead will be removed. The soldier pile will be +/-167' plus a wing wall on N side, in length to replace the concrete bulkhead in that area. The remaining bulkhead to the N, +/-33', will remain. The galvanized H beams will installed into the beach +/-9' below grade and +/-9' above grade. The precast concrete panels will be placed between the H beams and be installed +/-3' below beach grade and a total of+/-9' above. Earth anchors will be placed 10 on center and attached to a wailer on the face of the bulkhead. The piling on the shoreline in front of the bulkhead were removed from the beach. 6b. Describe the purpose of the project and why you want or need to perform it. hf el The purpose of the emergency bulkhead replacement was determined necessary as the old concrete bulkhead was being damaged and placing the home in danger. 6c. Indicate the project category. (Check all that apply.)Lhel ❑ Commercial ® Residential ❑ Institutional ❑ Transportation ❑ Recreational ❑ Maintenance ❑ Environmental Enhancement 6d. Indicate the major elements of your project. (Check all that apply.) hf e-M ❑ Aquaculture ❑ Culvert ❑ Float ❑ Retaining Wall ❑ Bank Stabilization ❑ Dam /Weir ❑ Floating Home (upland) ❑ Boat House ❑ Dike/ Levee/Jetty ❑ Geotechnical Survey ❑ Road ❑ Boat Launch ❑ Ditch ❑ Land Clearing ❑ Scientific ❑ Boat Lift ❑ Dock/ Pier ❑ Marina / Moorage Measurement Device ❑ Bridge ❑ Dredging ❑ Mining ❑ Stairs ® Bulkhead ❑ Fence ❑ Outfall Structure ❑ Stormwater Facility ❑ Buoy ❑ Ferry Terminal ❑ Piling / Dolphin ❑ Swimming Pool ❑ Channel Modification ❑ Fishway ❑ Raft ❑ Utility Line ❑ Other: ORIA-revised 02/2020 Page 5 of 15 6e. Describe how you plan to construct each project element checked in 6d. Include specific construction methods and equipment to be used. hf elal • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100-year floodplain. Proposal includes the replacement of the existing concrete bulkhead, total +/-167' with a wing wall with a new precast concrete soldier pile bulkhead. The newer 33' concrete bulkhead will remain intact. Galvanized H beams will be placed every +/-10' and installed +/-9' down into the substrate and above grade for a total of+/-9'to match existing height. Precast concrete panels will be installed between the beams with a total of+/-3' below grade and the remaining to match height of beams above grade. Earth anchors will be installed landward from the bulkhead and tied to the bulkhead with C channel iron and all thread. Precast concrete steps will be installed into the precast concrete solider pile bulkhead, face of steps to be located landward of the face of the bulkhead. The bulkhead and steps will be installed no further waterward than the face of the existing bulkhead. All concrete from old bulkhead will be removed from the site and disposed of. All pilings and concrete groins on the beach will be removed and hauled off. Approximately 9 pin piles will be installed under the waterside of the house for added stability. Primary access of equipment and materials will be by land. Work to remove the piling on the beach and also work in front of the house will require machines to be on the beach as there is no room to safely work from the land in front of the house. Request for 25'work corridor for material stockpile and machine use. 6f. What are the anticipated start and end dates for project construction? (MonthNear) h[ elpl • If the project will be constructed in phases or stages,use JARPA Attachment D to list the start and end dates of each phase or stage. Start Date: 01/09/2023 End Date: 01/15/2023 ❑ See JARPA Attachment D 6g. Fair market value of the project, including materials, labor, machine rentals, etc. JLel 255,675.00 6h. Will any portion of the project receive federal funding? hr elpl If yes,list each agency providing funds. ❑ Yes ❑ No ® Don't know Part 7 - Wetlands: Impacts and Mitigation ❑ Check here if there are wetlands or wetland buffers on or adjacent to the project area. (If there are none, skip to Part 8)LLeM 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. hf g10 ❑ Not applicable ORIA-revised 02/2020 Page 6 of 15 7b. Will the project impact wetlands? hf el ❑ Yes ❑ No ❑ Don't know 7c. Will the project impact wetland buffers? LhLel ❑ Yes ❑ No ❑ Don't know 7d. Has a wetland delineation report been prepared? hr elpl • If Yes,submit the report, including data sheets,with the JARPA package. ❑ Yes ❑ No 7e. Have the wetlands been rated using the Western Washington or Eastern Washington Wetland Rating System? hf el • If Yes,submit the wetland rating forms and figures with the JARPA package. ❑ Yes ❑ No ❑ Don't know 7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? hf e • If Yes,submit the plan with the JARPA package and answer 7g. • If No,or Not applicable,explain below why a mitigation plan should not be required. ❑ Yes ❑ No ❑ Not applicable 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. hf el 7h. Use the table below to list the type and rating of each wetland impacted, the extent and duration of the impact, and the type and amount of mitigation proposed. Or if you are submitting a mitigation plan with a similar table, you can state (below) where we can find this information in the plan. hC elpl ORIA-revised 02/2020 Page 7 of 15 Activity (fill, Wetland Wetland type Impact Duration Proposed Wetland drain, excavate, Name' and rating area (sq. of Impact3 mitigation mitigation area flood, etc.) category2 ft. or type+ (sq.ft. or Acres) acres) If no official name for the wetland exists,create a unique name(such as"Wetland 1"). The name should be consistent with other project documents,such as a wetland delineation report. z Ecology wetland category based on current Western Washington or Eastern Washington Wetland Rating System.Provide the wetland rating forms with the JARPA package. 3 Indicate the days,months or years the wetland will be measurably impacted by the activity.Enter"permanent'if applicable. °Creation(C),Re-establishment/Rehabilitation(R),Enhancement(E),Preservation(P),Mitigation Bank/In-lieu fee(B) Page number(s) for similar information in the mitigation plan, if available: 7i. For all filling activities identified in 7h, describe the source and nature of the fill material, the amount in cubic yards that will be used, and how and where it will be placed into the wetland. hf elal 7j. For all excavating activities identified in 7h, describe the excavation method, type and amount of material in cubic yards you will remove, and where the material will be disposed. of elal Part 8 - Waterbodies (other than wetlands): Impacts and Mitigation In Part 8, "waterbodies" refers to non-wetland waterbodies. (See Part 7 for information related to wetlands.) LLeM ® Check here if there are waterbodies on or adjacent to the project area. (If there are none, skip to Part 9.) 8a. Describe how the project is designed to avoid and minimize adverse impacts to the aquatic environment. ORIA-revised 02/2020 Page 8 of 15 hem ❑ Not applicable The replacement bulkhead was installed landward of the existing bulkhead and the old bulkhead removed. All concrete groins and derelict pilings on the beach were removed. 8b. Will your project impact a waterbody or the area around a waterbody? hf elpl ❑ Yes ® No 8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? h( e • If Yes,submit the plan with the JARPA package and answer 8d. • If No, or Not applicable,explain below why a mitigation plan should not be required. ® Yes ❑ No ❑ Not applicable 8d. Summarize what the mitigation plan is meant to accomplish. Describe how a watershed approach was used to design the plan. h[ elpl • If you already completed 7g you do not need to restate your answer here. hf e Removed 12" creosote pilings: +/-60 (1-3' above grade and unknown embedment). Concrete groin removal: estimated 15 running perpendicular to the bulkhead with pilings at each end, each +/-10' long and 1-2' into the beach, total of+/-150 square feet. Concrete steps: 1O'x3', total restored beach +/-30 square feet. 8e. Summarize impact(s) to each waterbody in the table below. hf elpl Activity (clear, Waterbody Impact Duration Amount of material Area (sq. ft. or dredge, fill, pile name' location2 of impact3 (cubic yards) to be linear ft.) of drive, etc.) placed in or waterbody removed from directly affected waterbody Remove (concrete Hood Canal In Permanent +/-11 cy +/-175' groins) Remove Pilings Hood Canal In Permanent +/-4 cy +/-175' ORIA-revised 02/2020 Page 9 of 15 Remove (Concrete Hood Canal In Permanent +/-10 Cy +/-175' Steps) Soldier Pile Hood Canal Adjacent Permanent +/-77 cy +/-175' If no official name for the waterbody exists,create a unique name(such as"Stream 1")The name should be consistent with other documents provided. z Indicate whether the impact will occur in or adjacent to the waterbody. If adjacent, provide the distance between the impact and the waterbody and indicate whether the impact will occur within the 100-year flood plain. 3 Indicate the days,months or years the waterbody will be measurably impacted by the work. Enter"permanent'if applicable. 8f. For all activities identified in 8e, describe the source and nature of the fill material, amount (in cubic yards) you will use, and how and where it will be placed into the waterbody. hf eM No fill in waterbody, all soldier pile was installed landward of old concrete bulkhead. 8g. For all excavating or dredging activities identified in 8e, describe the method for excavating or dredging, type and amount of material you will remove, and where the material will be disposed. hf elpl Removal of piling, steps and groins required minimal excavation. Part 9 - Additional Information Any additional information you can provide helps the reviewer(s) understand your project. Complete as much of this section as you can. It is ok if you cannot answer a question. 9a. If you have already worked with any government agencies on this project, list them below. LheI Agency Name Contact Name Phone Most Recent Date of Contact Mason County Julie Lewis ( ) Feb 2023 WDFW Sarah Henneford ( ) Feb 2023 9b. Are any of the wetlands or waterbodies identified in Part 7 or Part 8 of this JARPA on the Washington Department of Ecology's 303(d) List? nL elpl • If Yes,list the parameter(s)below. ORIA-revised 02/2020 Page 10 of 15 • If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at: http://www.ecy.wa.gov/programs/wq/303d/. ❑ Yes ® No 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? [t@_!PJ • Go to http://cfpub.epa.gov/surf/locate/index.cfm to help identify the HUC. 17110019 9d. What Water Resource Inventory Area Number (WRIA#) is the project in? hel • Go to ham://www.ecy.wa.gov/services/gis/maps/wria/wria.htm to find the WRIA#. 15 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? [tg!pJ • Go to http://www.ecy.wa.gov/programs/wq/swgs/criteria.htmI for the standards. ® Yes ❑ No ❑ Not Applicable 9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? hf eliA • If you don't know, contact the local planning department. • For more information,go to: http://www.ecy.wa.gov/programs/sea/sma/laws rules/173-26/211 designations.htm1. ® Rural ❑ Urban ❑ Natural ❑ Aquatic ❑ Conservancy ❑ Other: 9g. What is the Washington Department of Natural Resources Water Type? h� e • Go to http//www dnr wa gov/BusinessPermits/Topics/ForestPracticesApplications/Pages/fp watertyping aspx for the Forest Practices Water Typing System. ® Shoreline ❑ Fish ❑ Non-Fish Perennial ❑ Non-Fish Seasonal 9h. Will this project be designed to meet the Washington Department of Ecology's most current stormwater manual? hf elpl • If No, provide the name of the manual your project is designed to meet. ® Yes ❑ No Name of manual: 9i. Does the project site have known contaminated sediment? hel • If Yes, please describe below: ❑ Yes ® No ORIA-revised 02/2020 Page 11 of 15 9j. If you know what the property was used for in the past, describe below. h[ e Unknown 9k. Has a cultural resource (archaeological) survey been performed on the project area? h[ el • If Yes,attach it to your JARPA package. ❑ Yes ® No 91. Name each species listed under the federal Endangered Species Act that occurs in the vicinity of the project area or might be affected by the proposed work. h[ eipl Marbeld murrelet, spotted owl, chinook salmon, steelhead, killer whale, humpback whale, gray wolf 9m. Name each species or habitat on the Washington Department of Fish and Wildlife's Priority Habitats and Species List that might be affected by the proposed work. hf el Habitat: Puget Sound Nearshore Species: Pacific Lamprey, River Lamprey,White Sturgeon,Pacific Herring,Longfin Smelt,Surfsmelt,Bull Trout/ Dolly Varden,Chinook Salmon,Chum Salmon,Coastal Res./ Searun Cutthroat,Coho,Pink Salmon,Rainbow Trout/ Steelhead/ Inland Redband Trout,Pacific Cod,Pacific Hake,Walleye Pollock,Black Rockfish,Bocaccio Rockfish Brown Rockfish,Copper Rockfish,Greenstriped Rockfish,Quillback Rockfish,Redstripe Rockfish,Tiger Rockfish Yellowtail Rockfish,Lingcod,Pacific Sand Lance,English Sole,Rock Sole,Western Toad,Pacific Pond Turtle, Common Loon,Common Murre,Marbled Murrelet,Tufted Puffin,Western grebe,W WA nonbreeding concentrations of: Loons, Grebes, Cormorants, Fulmar, Shearwaters, Storm-petrels, Alcids W WA breeding concentrations of: Cormorants, Storm-petrels, Terns. Alcids, Great Blue Heron,Brant,Cavity-nesting ducks: Wood Duck, Barrow's Goldeneye, Common Goldeneye, Bufflehead, Hooded Merganser,Western Washington nonbreeding concentrations of: Barrow's Goldeneye, Common Goldeneye, Buff lehead,Harlequin Duck,Trumpeter Swan,Waterfowl Concentrations ,Bald Eagle Peregrine Falcon,Mountain Quail,Sooty Grouse,"W WA nonbreeding concentrations of:Charadriidae, Scolopacidae, Phalaropodidae "Band-tailed Pigeon Yellow-billed Cuckoo, Vaux's Swift,Pileated Woodpecker Purple Martin,Dall's Porpoise,Humpback Whale,Gray Whale,Sperm Whale,Harbor Seal,Orca (Killer Whale) ORIA-revised 02/2020 Page 12 of 15 Pacific Harbor Porpoise,California Sea Lion,Steller(Northern) Sea Lion,Roosting Concentrations of: Big-brown Bat, Myotis bats, Pallid Bat,Townsend's Big-eared Bat,Keen's Long-eared Bat (formerly Keen's Myotis) Columbian Black-tailed Deer,Pinto (Northern)Abalone,Geoduck ,Butter Clam,Native Littleneck Clam Manila Clam,Olympia Oyster,Pacific Oyster,Dungeness Crab,Pandalid shrimp (Pandalidae),Puget Blue Part 10 - SEPA Compliance and Permits Use the resources and checklist below to identify the permits you are applying for. • Online Project Questionnaire at http://apps.oria.wa.gov/opas/. • Governor's Office for Regulatory Innovation and Assistance at(800) 917-0043 or help(cDoria.wa.gov. • For a list of addresses to send your JARPA to, click on agency addresses for completed JARPA. 10a. Compliance with the State Environmental Policy Act (SEPA). (Check all that apply.) hf elpl • For more about SEPA,go to www.ecy.wa.gov/programs/sea/sepa/e-review.html ❑ A copy of the SEPA determination or letter of exemption is included with this application. ® A SEPA determination is pending with Mason Co (lead agency). The expected decision date is ❑ I am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 10b) hf e ❑ This project is exempt (choose type of exemption below). ❑ Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt? ❑ Other: ❑ SEPA is pre-empted by federal law. 10b. Indicate the permits you are applying for. (Check all that apply.) ILgipl LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance ®Shoreline Exemption Type (explain): Replacement of existing bulkhead to protect a SFR Other City/County permits: ❑ Floodplain Development Permit ❑ Critical Areas Ordinance STATE GOVERNMENT Washington Department of Fish and Wildlife: ® Hydraulic Project Approval (HPA) ❑ Fish Habitat Enhancement Exemption -Attach Exemption Form ORIA-revised 02/2020 Page 13 of 15 Washington Department of Natural Resources: ❑ Aquatic Use Authorization Complete JARPA Attachment E and submit a check for$25 payable to the Washington Department of Natural Resources. Do not send cash. Washington Department of Ecology: ❑ Section 401 Water Quality Certification ❑ Non-Federally Regulated Waters FEDERAL AND TRIBAL GOVERNMENT United States Department of the Army permits (U.S. Army Corps of Engineers): ❑ Section 404 (discharges into waters of the U.S.) ❑ Section 10 (work in navigable waters) United States Coast Guard: For projects or bridges over waters of the United States,contact the U.S.Coast Guard at: d13-pf-d13bridges@uscg.mil ❑ Bridge Permit ❑ Private Aids to Navigation (or other non-bridge projects) United States Environmental Protection Agency: ❑ Section 401 Water Quality Certification (discharges into waters of the U.S.) on tribal lands where tribes do not have treatment as a state (TAS) Tribal Permits: (Check with the tribe to see if there are other tribal permits,e.g.,Tribal Environmental Protection Act,Shoreline Permits, Hydraulic Project Permits,or other in addition to CWA Section 401 WQC) ❑ Section 401 Water Quality Certification (discharges into waters of the U.S.)where the tribe has treatment as a state (TAS). ORIA-revised 02/2020 Page 14 of 15 Part 11 - Authorizing Signature Signatures are required before submitting the DARPA package. the JARPA package includes the JARPA form, project plans, photos, etc. hf el 11 a. Applicant Signature (required) hI gio I certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurate. I also certify that I have the authority to carry out the proposed activities, and I agree to start work only after I have received all necessary permits. I hereby authorize the agent named in Part 3 of this application to act on my behalf in matters related to this application. (Initial) By initialing here, I state that I have the authority to grant access to the property. I also give my consent to the permitting agencies entering the property where the project is located to inspect the project site or any work related to the project. (Initial) Wendy Kramer See signed owner/agent agreement 2/27/23 Applicant Printed Name Applicant Signature Date I certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurate. I also certify that I have the authority to carry out the proposed activities and I agree to start work only after all necessary permits have been issued. Jennifer Rotsten A 2/28/23 Authorized Agent Printed Name Atoorized gent Signature Date 11 c. Property Owner Signature (if not applicant). hf el Not required if project is on existing rights-of-way or easements. I consent to the permitting agencies entering the property where the project is located to inspect the project site or any work. These inspections shall occur at reasonable times and, if practical, with prior notice to the landowner. Wendy Kramer Property Owner Printed Name Property Owner Signature Date 18 U.S.0 1001 provides that:Whoever, in any manner within the jurisdiction of any department of agency of the United States knowingly falsifies,conceals,or covers up any trick,scheme,or devise a material fact or makes any false,fictitious, or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false,fictitious,or fraudulent statement or entry,shall be fined not more than$10,000 or imprisoned not more than 5 years or both. If you require this document in another format,contact the Governor's Office for Regulatory Innovation and Assistance(ORIA) at(800) 917-0043. People with hearing loss can call 711 for Washington Relay Service. People with a speech disability can call (877)833-6341. ORIA publication number: ENV-019-09 rev. 09/2015 ORIA-revised 02/2020 Page 15 of 15