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HomeMy WebLinkAboutSHX2024-00029 Buoy - SHX Application - 7/10/2024 1 RECEIVE RECEIVED MASON COUNTY JUL 10 2024 COMMUNITY DEVELOPMENT 615 W. Alder Street Permit Assistance Center,Building,Planning PERMIT NOZ�Y201;1� +� SHORELINE EXEMPTION APPLICATION Shoreline development in Mason County must conform with the Mason County Shoreline Master Program. The program requires that substantial development (any development of which the total cost or fair market value exceeds $8,504.00 or materially interferes with the normal public use of the water or shorelines of the State) be reviewed with the goals, polices, and performance standards established in the Master Program. New or expanded docks or beach access structures will likely require a substantial development permit instead of a shoreline exemption. Consult with a Mason County Planner. APPLICANT: Justin & Lisa Harter ADDRESS: 1816 SW Walker Park Rd (street) Shelton WA 98584 (city) (state) (Z1p) PHONE: 970-402-9344 EMAIL: jharter@shelter-products.cfin1 AUTHORIZED REPRESENTATIVE: Leann Ebe ADDRESS: 9784 NE Lafayette Avenue (street) Bainbridge Island WA 98110 (city) (state) (zip) PHONE: 206-300-2678 EMAIL: leannm@mac.com Answer all questions completely. Attach any additional information that may further describe the proposed development. Incomplete application will be returned. PROPLRTY DESCRIPTION: General location (include property address, water body and associated wetlands—identify the name of the shoreline): 1816 SW Walker Park Rd, Shelton. The proposed buoy will be 250-feet from the shoreline in Oakland Bay. Include all parcel numbers: Projects located in open water areas, away from land shall provide latitude/longitude. 320215100014 Is the applicant the property owner? 0 YES () NO Owner: (street) (city) (state) (zip) Development proposal (identify and describe the proposed project, including the type of materials to be used, construction methods, principle dimensions, and other pertinent information): Screw in helical anchor. Attach line, mid-line float, chain and 24" white buoy with a reflective blue stripe. Existing Use (identify current use of property with exist improvements): Residential Reason for requesting development: Summer moorage for recreational boating. Estimated Fair Market Value of Project to Closest $1,000: $3000 ACKNOWLEDGMENT: I hereby declare, to the best of my knowledge and belief, the forgoing information and all attached information is true and correct. 0_6e� 6/28/24 (Applicant or Authorized Representative) (date) HARTER VICINITY MAP 47° 12' 23.36" N, -12")° 04' 14.36" W From Shelton, head South on Hwy 3. Turn left onto Fairmount Avenue, the right onto E Walker Park Rd. 1816 is on the left. Laurel St S` E Oak St N m ~ � E Fir St ° W Birch St = "der St w E Bfmh St L! Hazel St z Shelton W cedar sr h Shelton Yacht Club 0 ©Wilde Irish Pub z LL z TI ° up W Grove St L "I e \Ritz Drive-In Munson Point Park St ^ Kneeland rk Mill St 3 �1816 Southeast Walker Park Road is ° 6 min mj wAve in " Cali Cut 2.2miles e t a5 ElknorAve7 Wall, M € � a E Dearborn Ave Bordeaux = Elementary School® & 0 Petcare Inn Animal Bellevue Ave $ DIcklnson Ave Boarding Kennel Purpose: Mooring buoy for summer REFERENCE APPLICANT: PROPOSED: Install mooring moorage. Justin & Lisa Harter buoy for summer moorage for DATUM MLLW-0'0" NOF LOCATION ADDRESS: powerboat. ADJACENT PROPERTY OWNERS: 1816 SE Walker Park Rd IN: Oakland Bay, Puget W: 011i et al, Larry & Andrea Ward Shelton, WA 98584 Sound E: Ladenburg, Francis & Denise DATE: February 28, 2024 NEAR/AT: Shelton gev ',/2"1/Z� COUNTY: Mason STATE: WA �. HARTER SITE PLAN - PROPOSED N ` Scale: ` •� _� Proposed Mooring Buoy r' = 100' 47d 12' 23.36" OAKLAND BAY 00' 50' - 4' 14.3 6" '•� 250' 39' -- -- _ 111'------T--- 82'---- 34, — 7 / • MLLW=0.0' 131' 111' 145' 116' OHW—P/L Shoreline—__P/L--_105' SFR SFR SFR 123' SFR SFR D O Subject Property SFR Justin & Lisa Harter 1816 SE Walker Park Dr. Shelton,WA 98584 733' / SFR 830' 834' 1804 SE Walker 659' 1810 1816 SE Walker SE Walker 562' 1828 SE Walker REFERENCE: APPLICANT: Justin & Lisa Harter PROPOSED: Install mooring buoy with helical anchor. Qttf 3/Z71.?J-1 AT. Oakland Bay COUNTY: MASON STATE: WA DATE: February 28, 2024 SE Walker Park Rd 1 •\ �. HARTER SITE PLAN - PROPOSED Scale: .� Proposed Mooring Buoy V s 100' 47d 12' 23.36' OAKLAND BAY 4' 14.36" \' V6 250' ley.i� 39' T --- 107.- - --106'-. ---- • MLLW=0.0' 34 131' 111' 145' 116' ORW—P/L Shoreline �105' SFR SFR SFR SFR 123' SFR O O Subject Property SFR Justin & Lisa Harter 1816 SE Walker Park Dr. Shelton,WA 98584 733' / SFR 830' 834' 1804 SE Walker 659' 1810 1816 SE Walker SE Walker 562' 1828 SE Walker REFERENCE: APPLICANT Justin & Lisa Harter PROPOSED: Install mooring buoy with helical anchor. Q4V 3/V7 2-A-1 AT Oakland Bay COUNTY. MASON STATE: WA DATE: February 28, 2024 SE Walker Park Rd AorAkk of 'ty Programmatic Buoys SSDP Cross-Sectional View Worksheet ..i•,� Bainbridge --�� Island GPS Location: 91 O rZ ' N by—113" o ' l�, 3.Utvv Owner: JU,hhIyl 4 1.15a. PG•✓1P✓ STEP 1 (Subject to verification by the City) DNR Lease/License# _ Bottom Depth = " � ! Y p � �� � feet MLLW Buoy 11 (At mean low, low water or tide) ' (Minimum Depth=-9 feet MMLW l Maximum Depth =-18 feet MMLM Reflector----- I Surface Color: White Banding Color: Blue STEP 2 Type of Line? Bottorn Depth Extreme High water(14'5") _ Depth Extreme High Tide (DENT) D HT j + Scope> = Length of Line(L) M 1/ Flo ELw at i-- Bottom Depth less extreme low Located oaten 1!3 of Line Length i water(-4.5')=depth extreme low tide (DELT) No Eelgrass or I L STEP 3 Macroalgae I 8D � - ' DELT Present I Eelgrass or f!_ — �'� AM MacroalgaeDELTEcology Block V Embedment — Anchor option I Anchor option with dive survey without dive STEP 4 ** �p2 - survey Swing (L) -(DELT)` ,� i 30,(P I I I aCheck One. ♦ iL ,_ Bowline + �j� Vessel Length Swing - 1 Show Swing on Plan View 'ry° Programmatic Buoys SSDP Cross-Sectional View Worksheet .-+•.�•• Bainbridge ` Island GPS Location: yJ°IZZ�.Jio"' N by-123°STEP 1 !� (Subject to verification b Iq' 3,� W Owner: J��-�1✓I 4 J,t5Gi. j-�it�fi✓ Y the City) . DNR Lease/License# �. X Bottom Depth = feet MLLW Buoy (At mean low, low water or tide) ` (Minimum Depth=-9 feet MMLW Reflector---,---.- � r� —��"�_ Maximum Depth=-18 feet MMLW) Surface Color:White Banding Color: Blue STEP 2 1 Type of Line? I _ i j Bottom Depth +fExtreme High Water(14'5") _ �D pe th Extreme High Tide (pEHT) DEHT ; + Scope >20��I = Length of Line(L) 'ZOr' ELW .5 3.6 � Mid-Line Float \ Bottom Depth less extreme low Located oaten 1/3 of Line Length j water(-4.5')=depth extreme low tide (DELT) No Eelgrass or 1 l Macroalgae STEP 3 ; _ �---"----- Present Eelgrass or I� T '— ^I a'S — DELT Macroalgae Present PELT= Ecology Block V IBottom Embedment Anchor option I `--� Anchor option with dive survey i without dive STEP 4 0. - i survey **Swing (L`) - (DELT)`' ; 30.(� I I ..- I I Check One ♦ _5! Bowline + Vessel Length _r5101 Swing - 1 **Show Swing on Plan View I a wow Harter Site Photo tl d a Harter Site Photo jA AV F 9 " Vll ' � �i,.t mot` �' ..�• ��R, ,�:,�� ,:r t --------------------------- a�STA}F Q AGENCY USE ONLY LO f � I WASHINGTON STATE US Army s y, Engineers , Date received. of En iners Seattle District Joint Aquatic Resources Permit ' Application (JARPA) Form',2 Agency reference#: 0 USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW. Tax Parcel#(s): 3.l dr21-:51—00014 i -------------------------------------- Part 1—Project Identification 1. Project Name (A name for your project that you create. Examples: Smith's Dock or Seabrook Lane Development) Harter Buoy Part 2—Applicant 2a. Name (Last, First, Middle)3720 Point White Drive NE Harter, Justin & Lisa 2b. Organization (If applicable) 2c. Mailing Address (Street or PO Box) 2007 Shoreline Court 2d. City, State, Zip Windsor, CO 80550 2e. Phone(1) 2f. Phone(2) 2g. Fax 2h. E-mail 970-402-9344 jharter@shelter-products,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/CivilWorks/Regulatory/PermitGuidebook/EndangeredSr)ecies.asl)x. • 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. 2To access an online JARPA form with[help]screens,go to http://www.epermitting.wa.gov/site/alias resourcecenter/iarpa iarpa form/9984/iarpa form.aspx. For other help,contact the Governor's Office for Regulatory Innovation and Assistance at(800)917-0043 or help(a)oria.wa.goy. ORIA-16-011 Page 1 of 10 Part 3-Authorized Agent or Contact 3a. Name (Last, First, Middle) McDonald, Leann Ebe 3b. Organization Shoreline Solutions LLC 3c. Mailing Address (Street or Po Box) 9784 NE Lafayette Avenue NE 3d. City, State, Zip Bainbridge Island, WA 98110 3e. Phone(1) 3f. Phone(2) 3g. Fax 3h. E-mail 206-300-2678 leannm@mac.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. Z Same as applicant. (Skip to Part 5.) ❑ Repair or maintenance activities on existing rights-of-way or 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) 4b. Organization (It applicable) 4c. Mailing Address (street or Po Box) 4d. City, State, Zip 4e. Phone(i) 4f. Phone(2) 4g. Fax 4h. E-mail ORIA-16-011 Page 2 of 10 Part 5—Project Location(s) ❑ There are multiple project locations. Complete the section below and use JARPA Attachment B 5a. Indicate the type of ownership of the property. (Check all that apply.) ® 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) 511b. Street Address (cannot be a PO Box. If there is no address, provide other location information in 5p.) 1816 SE Walker Park Road 5c. City, State, Zip(If the project is not in a city or town, provide the name of the nearest city or town.) Shelton, WA 98584 5d. County Mason 5e. Provide the section, township, and range for the project location. 1/4 Section Section Township Range 21 20N 3W 5f. Provide the latitude and longitude of the project location. Example: 47.03922 N lat./-122.89142 W long. 47.206489 N,- 123.070656 W 5g. List the tax parcel number(s) for the project location. 320215100014 5h. Contact information for all adjoining property owners. (If you need more space, use JARPA Attachment C.) h( el Name Mailing Address Tax Parcel # (if known) W: 011i et al, Larry & Andrea Ward 1810 SE Walker Park Rd 320215100013 Shelton, WA 98584 E: Ladenburg, Francis & Denise 1309 Palm Dr 320215100015 Fircrest, WA 98466 5i. List all wetlands on or adjacent to the project location. No wetlands 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. Oakland Bay, Puget Sound 5k. Is any part of the project area within a 100-year floodplain? Z Yes ❑ No ❑ Don't know 51. Briefly describe the vegetation and habitat conditions on the property. Property surrounding home consists of landscaped gardens, deciduous & evergreen trees and shrubs. 5m. Describe how the property is currently used ORIA-16-011 Page 3 of 10 Residential — single family 5n. Describe how the adjacent properties are currently used Residential — single family to the East and West. 5o. Describe the structures (above and below ground) on the property, their purpose(s) and current condition. Single family residence is one-story in good condition. Bulkhead and private beach. 5p. Provide driving directions from the closest highway to the project location, and attach a map. From Shelton, head South on Hwy 3. Turn left onto Fairmount Avenue, the right onto E Walker Park Rd. 1816 is on the left. Part 6—Project Description 6a. Briefly summarize the overall project. You can provide more detail in 6b. Install helix anchor, chain, mid-line buoy, and floatation buoy. 6b. Describe the purpose of the project and why you want or need to perform it. Seasonal (spring/summer moorage) for small power boat. The anchor is helix, and the chain and mid-line float will be inspected by the installer annually. 6c. Indicate the project category. (check all that apply) ❑ Commercial ❑x Residential ❑ Institutional ❑ Transportation ❑x Recreational ❑ Maintenance ❑ Environmental Enhancement 6d. Indicate the major elements of your project. (check all that apply) ❑ 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 Measurement Device ❑ Boat Lift ❑ Dock/ Pier ❑ Marina / Moorage ❑ Stairs ❑ Bridge ❑ Dredging ❑ Mining ❑ Stormwater facility ❑ Bulkhead ❑ Fence ❑ Outfall Structure ❑ Swimming Pool ❑x Buoy ❑ Ferry Terminal ❑ Piling/Dolphin ❑ Utility Line ❑ Channel Modification ❑ Fishway ❑ Raft ❑ Other: 6e. Describe how you plan to construct each project element checked in 6d. Include specific construction methods and equipment to be used. • Identify where each element will occur in relation to the nearest waterbody. Indicate which activities are within the 100-year floodplain. ORIA-16-011 Page 4 of 10 • Diver screws in Helix Anchor • Attach chain • Attach mid line buoy • Attach floatation buoy with required identification 6f. What are the anticipated start and end dates for project construction? (Month/Year) • 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: Summer 2024 End Date: 2-3 hours ❑ See JARPA Attachment D 6g. Fair market value of the project, including materials, labor, machine rentals, etc. $2,000 6h. Will any portion of the project receive federal funding? If yes, list each agency providing funds. ❑ Yes ❑x 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 none,skip to Part 8.) 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. ❑ Not applicable 71b. Will the project impact wetlands? ❑ Yes ❑ No ❑ Don't know 7c. Will the project impact wetland buffers? ❑ Yes ❑ No ❑ Don't know 7d. Has a wetland delineation report been prepared? 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? 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? If Yes, submit the Ian with the JARPA package and answer 7 . If No, or Not applicable, explain below why a mitigation plan should not be required. ❑ Yes ❑ No ❑ Don't know 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. 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. ORIA-16-011 Page 5 of 10 Activity (fill, Wetland Wetland Impact Duration Proposed Wetland drain, excavate, Name' type and area (sq. of impact3 mitigation mitigation area flood, etc.) rating ft. or type' (sq. ft. or category' 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. 2 Ecology wetland category based on current Western Washington or Eastern Washington Wetland Rating System.Provide the wetland rating forms with the JARPA package. 3Indicate 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. 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. 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.) ❑x 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. ❑ Not applicable Helix anchor instead of ecology block. Mid-line float to prevent scouring. 81b. Will your project impact a waterbody or the area around a waterbody? ❑ Yes 11 No 8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? 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 ❑ Don't know 8d. Summarize what the mitigation plan is meant to accomplish. Describe how a watershed approach was used to design the plan. If you already completed 7g you do not need to restate your answer here. No mitigation plan provided. 8e. Summarize impact(s) to each waterbody in the table below. Activity (clear, Waterbody Impact Duration Amount of material Area (sq. ft. or dredge, fill, pile name' location of impact' (cubic yards) to be linear ft.) of drive, etc.) placed in or removed waterbody from waterbody directly affected Helix screw Puget Sound Oakland permanent One anchor 1 foot anchor Bay ORIA-16-011 Page 6 of 10 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. 2Indicate 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. 3Indicate 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. No fill 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. No excavating or dredging. 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. 9a. If you have already worked with any government agencies on this project, list them below. Agency Name Contact Name Phone Most Recent Date of Contact USACE 9b. Are any of the wetlands or waterbodies identified in Part 7 or Part 8 of this DARPA on the Washington Department of Ecology's 303(d) List? If Yes, list the parameter(s) below. 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 ❑x No 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? • Go to http://cfpub.epa.goy/surf/locate/index.cfm to help identify the HUC. 17110018 9d. What Water Resource Inventory Area Number (WRIA#) is the project in? • Go to http://www.ecy.wa.goy/water/wria/index.html to find the WRIA#. 14 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? • Go to http://www.ecy.wa.gov/programs/wq/swgs/criteria.htmI for the standards. ❑ Yes ❑ No ❑x Not applicable 9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? • For more information, go to: http://www.ecy.wa.goy/programs/sea/sma/laws rules/173-26/211 designations.html. ❑ Urban ❑ Natural ❑x Aquatic ❑ Conservancy ❑ Other: ORIA-16-011 Page 7 of 10 9g. What is the Washington Department of Natural Resources Water Type? • Go to http://www.dnr.wa.gov/forest-practices-water-tVping for the Forest Practices Water Typing System. 0 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? If No, provide the name of the manual your project is designed to meet. 0 Yes ❑ No Name of manual: Current stormwater manual 9i. Does the project site have known contaminated sediment? If Yes, please describe below. ❑ Yes CX No 9j. If you know what the property was used for in the past, describe below. Residential 9k. Has a cultural resource (archaeological) survey been performed on the project area? • If Yes, attach it to your JARPA package. ❑ Yes 0 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. Marbled Murrelet, Puget Sound Chinook Salmon, Georgia Basin bocaccio, rockfish (yelloweye, canary & bocaccio), Southern Resident killer whale. 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. No affect by proposed work. 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(a_oria.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.) • For more information 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 . The expected decision date is ❑ I am applying for a Fish Habitat Enhancement Exemption. (check the box below in yob.) 0 This project is exempt (choose type of exemption below). 0 Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt? 173-27-040 (2) (a) t k a f 1 5 apt. e,x0w► W 5y0 ,5 P4 ;a I Jevelo?&" I', ,- - 51 � T ❑ Other: 56 Exee4pho V% ; VA(, El SEPA is pre-empted by federal law. T�0-6 - ORIA-16-011 Page 8 of 10 10b. Indicate the permits you are applying for. (Check all that apply.) LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance ❑x Shoreline Exemption Type (explain): WAC 173-27-040 (2) (a) 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 ❑ My project is exempt from the application fee. (Check appropriate exemption): ❑ HPA processing is conducted by applicant funded WDFW staff. Agreement# ❑ Mineral prospecting and mining ❑ Project occurs on farm and agricultural land_ (Attach a copy of current land use classification recorded with the county auditor, or other proof of current land use) 56 Project is modification of an existing HPA originally applied for, prior to July 10, 2012. HPA# I 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. Washington Department of Ecology: ❑ Section 401 Water Quality Certification FEDERAL 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 permits: ❑ Private Aids to Navigation (for non-bridge projects) ORIA-16-011 Page 9 of 10 Part 11—Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. 11 a. Applicant Signature (required) 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. JH (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. JH (initial) Juli t v Justin Harter J";, HA4V , Febrtimy-2219, 2024 Applicant Printed Name Applicant Signature Date 11 b. Authorized Agent Signature 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. Leann Ebe Fe� , 2024 Authorized Agent Printed Name Authorized Agent Signature Date 11 c. Property Owner Signature (if not applicant) Not required if project is on existing rights-of-way or easements (provide copy of easement with JARPA). 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. 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 or agency of the United States knowingly falsifies, conceals, or covers up by any trick, scheme,or device 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: ORIA-16-011 rev.09/2016 ORIA-16-011 Page 10 of 10