HomeMy WebLinkAboutNOA - JARPA'l
AGENCY USE ONLY
ffi WASHINGTON STATE
Joint Aquatic Resources Permit
Application (JARPA) Form{'2
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US AIlrly Co.p€
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Date received:
USE BLACK OR BLUE INK TO ENTER ANSWERS IN TI{E WHITE SPACES BELOW.
I-EC}IE IVIE
Part {-Project ldentification JEFTERSON Cr)UIIIY
Part 2-Applicant
The person and/or organization responsible for the project. rnetpl
. Project Name (A name for your project that you create Seabrook Lane Development) fhelpJ1
Savidge replacement bulkhead proJect
2a. Name (Last, First, Middle)
Savidge, Edward
2b. Organization (tf appticabte)
2C. Mailing Address (Street or Po Box)
485 Griffith Point Rd
2d. City, State, Zip
Nordland, WA 98358
2e. Phone 1ry 2f. Phone (z)2g. Fa><2h. E-mail
360-301-9902 ()esavidge@olypen.com
lAdditional forms may be required for the following permits:
o lf your project may qualify for Department of the fumy authorization through a Regional General Permit (RGP), contact the U.S. Army Corps ol
Engineers for application information (206) 76,4-3495.o lf your project might affect species listed under the Endangered Species Act, you will need to fill out a Specific Project lnformation Form (SPIF) or
prepare a Biological Evaluation. Forms can be found at
http://www.nws.usace.army.mil/PublicMenu/Menu.cfm?sitename=REG&paqename=mainpaqe ESA. Not all cities and counties accept the JARPA for their local Shoreline permits. lf 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 wttr [help] screens, go to
htto://www.eoermittino.wa.qov/site/alias resourcecenter/iarpa iarpa form/9984/iarpa form.asox.
For other help, contact the Governor's Office of Regulatory Assistance at 1-800-917-0043 or help@ora.wa.qov.
JARPA Revision 2012.1 Page 1 of 14
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Agency reference #z _
Tax Parcel #(s): _
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Part 3-Authorized Agent or Gontact
Person authorized to represent the applicant about the project. (Note: Authorized agent(s) must sign 1 1b of this
application.) tnetpt
3a. Name (Last, First, Middle)
Rehe, William
3b. Organization (lf applicable)
North Fork Environmental
3c. Mailing Address (street or Po Box)
8305 Dogwood Lane NW
3d. City, State, Zip
Gig Harbor, WA 98332
3e. Phonenl 3f. Phone tzt 39. Fax 3h. E-mail
253-389-0712 ()()bil l@northforkenvi ron mental.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 aouatic ownership because the upland owners may not own the adjacent aquatic land. tnetpl
X Same as applicant. (Skip to Part 5.)
n Repair or maintenance ac'tivities on existing rights-of-way or easements. (Skip to Part 5.)
f There are multiple upland property owners. Complete the section below and fillout JARPA Attachment A for
each additional property owner.
Your project is on Department of Natural Resources (DNR)-managed aquatic lands. lf you don't know,
contact the DNR at (360) 902-1100 to determine aquatic land ownership. lf yes, complete JARPA Attachment E
to apply for the Aquatic Use Authorization.
4a. Name (Last, First, Middle)
4b. Organization (tf appticabte)
4c. Mailing Address (Street or Po Box)
4d. City, State, Zip
4e. Phone (r)4f. Phone (z)49. Fax 4h. E-mail
()()(
JARPA Revision 2012.1 Page 2 of 14
)
5a. lndicate the type of ownership of the property. (cneck all that apply.) fhelpl
ffi Private
I Federal
D puUllcly owned (state, county, city, specialdistricts like schools, ports, etc.)
n trioat
I Department of Natural Resources (DNR) - managed aquatic lands (Complete JARPA Attachment E)
5b. Street Address (Cannot be a PO Box. lf there is no address, provide other location information in 5p.) thelpl
485 Griffith Point Rd,
5C. City, State, Zipttttheprojectisnotinacityortown, providethenameof thenearestcityortown.) lhelp]
Nordland, WA 98358
5d. Count! therpl
Jefferson
5e. Provide the section, township, and range forthe p@ect location. trrerpt
% Section Section Township Range
SW 32 30N 1E
5f. Provide the latitude and longitude of the project location. trretpl
o Example: 47.03922 N lat. / -122.89142 W long. (Use decimal degrees - NAD 83)
48. 043440" I -1 22.7 0 1 362"
59. List the tax parcel number(s) for the projec't location. herpl
o The local county assessol's office can provide this information.
021324009
5h. Contact information for all adjoining property owners. (lf you need more space, use JARpA Attachment C.) herpt
Name Mailing Address Tax Parcel # (if known)
EDWARDK&MARYK
WINSLOW
501 GRIFFITHS POINT RD 021324010
NORDI.AND 98358
MARGUERITE P SCHROEDER 461 GRIFFITHS POINT RD 021324008
NORDI.AND 98358
Part S-Project Location(s)
ldentifying information about the property or properties where the project will occur. tnetpl
flThere are multiple project locations (e.9. linear projects). Complete the section below and use JARPA
Attachment B for each additional p@ect location.
JARPA Revision 2012.1 Page 3 of 14
5i. List allwetlands on or adjacent to the project location. tnetpt
Estuarine lntertidal Aquatic Bed/Unconsolidated Shore, Regularly Flooded
5j. List all waterbodies (other than wetlands) on or adjacent to the project location. tnetot
Kilisut Harbor, Puget Sound
5k. ls any part of the project area within a 100-year floodplain? metpt
tr Yes I no ffi Don't know
51. Briefly describe the vegetation and habitat conditions on the property. ttretot
The shoreline riparian vegetation on this parcel has been mostly removed. Two madrone trees are located near
the northern property line. One large Douglas fir tree is located near the southern property line. Habitat
waterword of OHW is composed of coarse sand gravel and mudflats. According to WDFW Forage Fish
Spawning Map, surf smelt have been documented to spawn at and adjacent to the project site. Pacific herring
spawning has also been documented adjacent to the project site.
5m. Describe how the property is currently used. hetpl
The property has been used as a single family residence since 1980's
5n. Describe how the adjacent properties are currently used. hetpt
The adjacent properties are also used for single family residences.
5o. Describe the structures (above and below ground) on the property, including their purpose(s) and current
condition. tnetpl
Structure on or adjacent to the marine shoreline include an existing single family residence, bulkheads and
stairs, deck, patio, detached garagelshop and driveway.
JARPA Revision 20'12.1 Page 4 of 14
5p. Provide driving directions from the closest highway to the pro1ect location, and attach " Inop. lhelpl
From Port Towsend, take WA- 20 south.
Continue onto WA-19 south.
Turn left onto WA-116 easU Flagler Rd.
Turn left onto Griffith Point Rd.
The project site is on the left.
Part 6-Project Description
6a. Briefly summarize the overall pro1ect. You can provide more detail in 6b. tnetpl
The overall goals of this project is to replace the failing rock bulkhead and protect the single family
residence
6b. Describe the purpose of the project and why you want or need to perform it. tnetpt
A rock bulkhead was built on the property sometime around 1989. The bulkhead was not built properly
The rock used is fragmented marine basalt that easily fractures, no geotechnical fabric was used, the
angle of the bulkhead is too steep and the bulkhead footing was not properly enbeded into the beach.
We are proposing to move the replacement approximately two feet landward above OHW.
5C. lndicate the project category. (Check allthat apply) thelpl
E Commercial
E Maintenance
X Residential f lnstitutional I Transportation ! Recreational
! Environmental Enhancement
6d. lndicate the major elements of your project. (check allthat apply) [hetp]
I Aquaculture
E Bank Stabilization
I Boat House
E Boat Launch
I Boat Lift
E grioge
X Bulkheao
Buoy
Channel Modification
E Culvert
Dam / Weir
Dike/Levee/Jetty
E oitcn
E Docf / Pier
I Dredging
fl Fence
E ferry Terminal
I Fisnway
E Ftoat
! Floating Home
E Geotechnical Survey
f] Land Clearing
E Marina / Moorage
E uining
f Outtatl Structure
E Piling/Dolphin
I Ratt
I Retaining Wall
(upland)
I Road
f] Scientific
Measurement Device
Stairs
f] Stormwaterfacility
fl Swimming Pool
E utirty tine
E otner
JARPA Revision 2012.1 Page 5 of 14
6e. Describe how you plan to construct each project element checked in 6d
methods and equipment to be used. hetpl
o ldentify where each element will occur in relation to the nearest waterbody.
o lndicate which ac{ivities are within the lOGyear floodplain.
I nclude specific construction
The failing rock bulkhead will be removed and replaced two feet landward of the existing structure with an
angular rock bulkhead. Equipment and materialwill be brought in by barge. The equipment will operate in a25
foot work corridor directly in front of the existing bulkhead. The rock bulkhead will be removed and disposed of
at an approved upland disposal site. Large bulkhead rock will be placed approximately 1.5 feet below grade on
suitable material. Back fill materialwill be brought in via the barge and place with an excavator. Geotextile, coir
fabric and grass seed will be used, as ne@ssary, to stabilize the bank and prevent erosion. After completion of
work, manmade debris will be removed from the beach.
6f. What are the anticipated start and end dates for project construction? (Month/Year) lhetpl
o lf the project will be construcled in phases or stages, use JARPA Attachment D to list the start and end dates of each phase or
stage.
Start date: As soon as permits are received and tides allow work. End date: 3 weeks from start date.
I See JARPA Attachment D
69, Fair market value of the project, including materials, labor, machine rentals, etc. lnerpt
$
6h. Will any portion of the project receive federal funding? rnerpl
o If yes, list each agency providing funds.
I Yes X ruo E Don't know
Part 7-Wetlands: lmpacts and Mitigation
f] Cnecf here if there are wetlands or wetland buffers on or adjacent to the project area
(lf there are none, skip to Part 8.) frretpt
7a. Describe how the prolect has been designed to avoid and minimize adverse impacts to wetlands. lhelpl
I ttot applicable
7b. Willthe project impact wetlands? rnetpt
E Yes f ruo I Don't know
7c. Willthe project impact wetland buffers? trretpl
JARPA Revision 2012.1 Page 6 of 14
I Yes I ruo fl Don't know
7d. Has a wetland delineation report been prepared? thelpl
r lf Yes, submit the report, including dala sheets, with the JARPA package.
I Yes I t'{o
7e. Have the wetlands been rated using the Western Washington or Eastern Washington Wetland Rating
System? hetot
o lf Yes, submit the wetland rating forms and figures with the JARPA package.
f] Yes E tlo fl Don't know
7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? tnetpl
o lf Yes, submit the plan with the JARPA package and answer 79.
r lf No, or Not applicable, explain below why a mitigation plan should not be required.
I Yes E tto f] ttot applicable
79. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was
used to design the plan. rnetpl
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. hetp't
Activity (fi|!,
drain, excavate,
flood, etc.)
Wetland
Namel
Wetland
type and
rating
category2
lmpact
area (sq.
fL or
Acres)
Duration
of impacf
Proposed
mitigation
typeo
Wetland
mitigation area
(sq. ft. or
acres)
1 lf no official name for the wetland exists, create a unique name (such as lAletand 1'). The name should be consistent with other project documents, such
as a wetland delineation report.
2 Ecology wefland category based on cunent Western Washington or Eastern Washingrton Wedand Rating System. Provide the wetland
rating forms with the JARPA package.3lndicate the days, months or years the wetland will be measurably impacted by the activity. Enter "permanenf if applicable.
a Creation (C), Re-establishment/Rehabilitation (R), Enhancement (E), Preservation (P), Mitigation BanUln-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. trretpt
JARPA Revision 20'12.1 PageT ot 11
7i. 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. tnerot
Part 8-Waterbodies (other than wetlands): lmpacts and Mitigation
ln Part 8, \rvaterbodies" refers to non-wetland waterbodies. (See Part 7 for information related to wetlands,) tnetol
X CnecX here if there are waterbodies on or adjacent to the project area. (lf there are none, skip to Part 9.)
8a. Describe how the project is designed to avoid and minimize adverse impacts to the aquatic environment.
lhelpl
! ttot applicable
This project is the replacement of an existing angular rock bulkhead that has become dilapidated and rotted
overtime. The contractorwill avoid and minimize adverse impacts to the project area by working during the
authorized regulatory agency "work windows". The project was designed to minimize adverse impacts by
working within a 25 foot work corridor, only working in the dry at low tide and not stockpiling fine grain material
below MHHW. The barge will not ground out in any aquatic vegetation and the tug will operate in a mannerto
reduce prop wash.
8b. Will your project impact a waterbody orthe area around a waterbody? trretpl
X Yes E tlo
8c. Have you prepared a mitigation plan to compensate forthe projec't's adverse impacts to non-wetland
waterbodies? Irretpl
o lf Yes, submit the plan with the JARPA package and answer 8d.
o lf No, or Not applicable, explain below why a mitigalion plan should not be required.
JARPA Revision 2012-1 Page 8 of 14
fl Yes X uo I trtot applicable
No mitigation plan was prepared. The replacement of the existing single family residential bulkhead will not have
any additional long-term impacts to wetlands or non-wetland waterbodies. Temporary and short term impacts
will be mitigated by avoiding and minimizing impacts with Best Management Practices (BMPs) and conservation
practices. We are also proposing to move the bulkhead back approximately 2 feet, restoring approximately 300
sq.ft. of upper intertidal habitat. Additional mitigation will be provide by placing "fish mif gravel, as required by
WDFW.
8d. Summarize what the mitigation plan is meant to accomplish. Describe how a watershed approach was
used to design the plan.
o lf you already completed 79 you do not need to restate your answer here. lhelpl
The proposed mitigation is meant to compensate for temporary, short term impac'ts caused by operating
equipment on the beach and no meet no net loss of habitat or function.
8e. Summarize impact(s) to each waterbody in the table below. thetpl
Activity (clear,
dredge, fill, pile
drive, etc.)
Waterbody
namel
lmpact
location2
Duration
of impacf
Amount of material
(cubic yards) to be
placed in or
removed from
waterbody
Area (sq. ft. or
linear ft.) of
waterbody
directly affected
Remove failing
bulkhead
Kilisut Harbor ln -5-7 days - 35 cubic yards -100 linearfeet
Replace failed
existinq bulkhead
Puget Sound Adjacent -5-7 days - 35 cubic yards -l00linearfeet
1 lf no official name for the waterbody exists, create a unique name (such as 'Stream 1") The name should be consistent with other documents provided.
2lndicate whether the impact will occur in or adjacent to the waterbody. lf adjacent, provide the distance between the impact and the waterbody and
indicate whether the impact will occur within the 100-year flood plain.
3lndicate 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. lhetpl
No fill materialwill be placed into the waterbody. Bulkhead rock and quarry spalls will be sourced from
an upland quarry and brought in by barge.
89. 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 materialwill be disposed. tnetpl
JARPA Revision 2012.1 Page 9 of 14
No dredging will occur. A toe trench approximately 100' long by 3' wide was excavated in order to place the
bulkhead rock on a firm footing.
Part g-Add itional lnformation
Any additional information you can provide helps the reviewe(s) understand your projed. Complete as much of
this section as you can. lt is ok if you cannot answer a question.
9a. tt you have already worked with any government agencies on this project, list them below. hetpt
Agency Name Contact Name Phone Most Recent
Date of Contact
Jeferson County Donna Frostholm 9121117
9b. Are any of the wetlands or waterbodies identified in Part 7 or Part I of this JARPA on the Washington
Department of Ecology's 303(d) List? rnetpt
r ff Yes, list the parameter(s) below.
o lf you don't know, use Washington Department of Ecology's Water Quality Assessment tools at:
http://w!rnv. ecv.wa. qov/proorams/wqi303d/.
lYes Xruo
9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? Irrerpl
o Go to http:/icfpub.epa.qov/surf/locate/index.cfm to help identify the HUC.
17110019
9d. What Water Resource lnventory Area Number (WRIA #) is the project in? tnetot
o Go to http://www.ecv.wa.qov/services/ois/maos/wria/wria.htm to find the WRIA #.
WRIA 17
9e. Will the in-water construction work comply with the State of Washington water quality standards for
turbidity? fnetpt
o Go to http://www.ecv.wa.qov/proorams/wq/swqs/criteria.html for the standards.
Xyes Eruo I Not applicable
9f. lf the proiect is within the jurisdiction of the Shoreline Management Act, what is the local shoreline
JARPA Revision 2012.1 Page 10 of 't4
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. hetpl
The following species can be found in the Puget Sound. There will be no effect on these species by the
proposed work is expected.
Bocaccio rockfish (Sebasfes paucispinis) - Endangered
Bull trout (Salvelinus confluenfus) - Threatened
Canary rockfish (Sebasfes pinniger) - Threatened
Chinook salmon (Oncorhynchus fshawytscha) (Puget Sound) - Threatened
Marbled murrelet (Brachyramphus marmoratus) - Threatened
Steelhead (Oncorhynchus mykiss) (Puget Sound DPS) - Threatened
Southern resident killer whale (Orcinus orca )(Southern Resident DPS) - Endangered
Yelloweye rockfish (Sebasfes rubenimus) - Threatened
JARPA Revision 2012.1 Pagel1of14
environment designation? rnetpl
o lf you don't know, contact the local planning department.
o Formorsinformation,goto:htlp://uturryy.ec'\r.wa.qov/proorams/sea/sma/lavvs rules/173-26/211 desionations.html.
X Rural I Urban I Natural flAquatic ! Conservancy f] otner
99. What is the Washington Department of Natural Resources Water Type? metpt
o Go to http:/iwww.dnr.wa.oov/BusinessPermits/Topics/ForestPracticesApplications/PaoeJfp watertvpino.asox for the Forest
Practices Water Typing System.
E Non-Fish Perennial fl Non-Fish SeasonalX Shoreline E risn
th. Willthis project be designed to meet the Washington Department of Ecology's most cunent stormwater
manual? lnetpl
o lf No, provide the name of the menual your projec{ is designed to meet.
ffi Yes I tto
Name of manual: Western Washington Manual
9i. Does the project site have known contaminated sediment? hetplo lf Yes, please describe belorrr.
[Yes XNo
9i. lf you know what the property vras used for in the past, describe below. tnerpr
This property has had a house and other structures since the 't990's
9k. Has a cultural resour@ (archaeological) survey been performed on the project area? tnerol
r lf Yes, attach it to your JARPA package.
nYee Mrua
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. hetpl
According to WDFWs Priority Habitats and Species List lnteractive Online Mapper estuarine and marine
intertidal habitat, hardshell clams and Hening and surf smelt spawning habitat are located at and adjacent to the
project site.
Part 10-SEPA Gompliance and Permits
Use the resources and checklist below to identify the permits you are applying for
o Online Project Questionnaire at http://apps.ecy.wa.qov/opas/.. Governo/s Office of Regulatory Assistance at (800) 917-0043 or help@ora.wa.qov.o For a list of addresses to send your JARPA to, click on aqencv addresses for completed JARPA.
10a. Compliance with the State Environmental Policy Act (SEPA). lcnecr altthat appry.) Ihetol
o For more information about SEPA, go to www.ecv.wa.qov/proqrams/sea/sepa/e-review.html.
f] R copy of the SEPA determination or letter of exemption is included with this application
X n SgPn determination is pending with Jefferson County (lead agency). The expected
decision date is
I t am applying for a Fish Habitat Enhancement Exemption. (cneck the box betow in too.) Irretpt
This project is exempt (choose type of exemption below).
fl Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt?
E other:
E Sepn is pre-empted by federal law.
10b. lndicate the permits you are applying for. lctrecx attthat appty.) thetpl
Loclu Govenrunlterur
Local Government Shoreline permits:
E Substantial Development E Conditional Use I Variance
X Shoreline Exemption Type (explain):
Other city/cou nty permits :
X Floodplain Development Permit I Critical Areas Ordinance
Srare Govennurrur
JARPA Revision 2012.1 Page 12 ot 14
Washington Department of Fish and Wildlife:
X Hydraulic Project Approval (HPA) [ fisn Habitat Enhancement Exemptioo - Attach Exemption Form
Effective July 10, 2012, you must submit a check for $150 to Washington Department of Fish and Wildlife,
unless your project qualifies for an exemption or alternative payment method below. Do not send cash.
Check the appropriate boxes:
n $t SO check enclosed. (check
Attach check made payable to Washington Department of Fish and Wildlife.
I Cnarge to billing account under agreement with WDFW. (Agreement
Mytr project is exempt from the application fee. (check appropriate exemption)
HPA processing is conducted by applicant-funded WDFW staff.
(Agreement
trtr 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.)
Project is a modification of an existing HPA originally applied for, prior to July 10,2012.
(HPA
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.
Washlngton Department of Ecology:
X Section 401 Water Quality Certification
FeoeRRr GoveRruaaerur
United States Department of the Army permiB (U.S. Army Corps of Engineers):
I Section 404 (aiscnarges into waters of the U.S.) X Section 10 (work in navigabte waters)
United States Coast Guard permits:
E General Bridge Act Permit fl Private Aids to Navigation (for non-bridge projects)
JARPA Revision 2012.1 Page 13 of 14
#)
' Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form,
project plans, photos, etc. hp1pl
11a. Applicant Signature (required) helej
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 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 the authority to grant access to the property. I also give my consent to the
permitting agencies entering where the project is located to inspect the project site or any work
related to the project.(initial)
6 O-,+*t P, AxqrP&E 2*^,/ / C,."r,,r/rr l,
Applicant Printed Name Date
11b. Authorized Agent Signature 1t'relp]
I certrfy 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.
William Rehe
ApplicanaSfinature 7 <J
/I
I
Authorized Agent Printed Name Date
11c. Property Owner Signature (if not applicant). 1tre1g
Not required if project is on existing right+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.
Eannrra n €nurlcE 4 ,./r,/z
Property Orner Printed Name Date
18 U.S.C $1001 provides that Whoever, in any manner within the jurisdiciion of any deparUnent or agency of the United States knowrngly
falsifles, conceals, or @vers up by any trick, scheme, or device a material fact or makes any fulse, ficlitious, or traudulent statements or
representiations or makes or uses any false writing or document knowing same to contain any false, fictitious, or fiaudulent statement or
entry, shall be fined not more than $10,000 or imprisoned not more than 5 years or both.
lf you require this document in anolher format contact the Governo/s Offtce of Regulatory Assistance (ORA) at (800) 917-0043.
People with hearing loss can cr,ll711 for Washington Relay Service. People with a speech disability can call (877) 833€341.
ORA publication number: ENV-01909 rev, 0G12
Signature
JARPA Revisioo2A12.1 Page 14 ot 14
Property Owner Signaturg/