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. .... 1••; �J'j "11�:1Ptrc rr..r 1: <br />Did you know you can submit your NC I' �l ctrpriick <br />online system? www.ecy.wa.gov/pi-og ams/w /sfbr:mw, <br />NOTICE OF INTENT ( <br />APPLICATION FORM <br />Construction Stormwater General <br />DEPARTMENT OF Permit <br />ECOLOGY <br />State of Washington <br />sing our secure, easy to use <br />construction/enoi.html <br />Check if applicable: <br />❑ Change or Update Permit Information <br />❑ Modification of Permit Coverage <br />Permit #WAR <br />Please print or type all sections of this application. All fields are required unless otherwise marked.(use Itab) to navigate through fields) <br />(.Operator/Permittee (Party with operational control over plans and specifications or day-to-day operational control of activities that <br />ensure compliance with Stormwater Pollution Prevention Plan (SWPPP) and permit conditions. Ecology will send correspondence and <br />permit fee invoices to the permittee on record. <br />Name: Matt Finch <br />Company: Edmonds School District No.15 <br />E-mail:finchm@edmonds.wedneLedu <br />Unified Business Identifier (UBI): None <br />(UBI is a nine -digit number used to identify a business entity. <br />Business Phone: <br />Ext. <br />425-431-7167 <br />Write "none" if you do not have a UBI number.) <br />Cell Phone (Optional): <br />Fax (Optional): <br />Mailing Address: <br />City: <br />State: <br />Zip + 4: <br />20420 681h Avenue West <br />Lynnwood <br />WA <br />98036 <br />II. Property Owner (The party listed on the County Assessor's records as owner and taxpayer of the parcel[s] for which permit <br />coverage is requested. Ecology will not send correspondence and permit fee invoices to the Property Owner unless he/she is also <br />the permittee. The Property Owner information will be used for ern er enc contact purposes.) <br />Name: Edmonds School District No. 15 <br />Company (if applicable): N/A <br />Business Phone: <br />Ext. <br />Unified Business Identifier (UBI): None <br />425-431-7167 <br />(UBI is a nine -digit number used to identify a business entity. <br />Cell Phone (Optional): <br />Fax (Optional): <br />Write "none" if you do not have a UBI number.) <br />E-mail:finchm@edmonds.wednet.edu <br />Mailing Address: City: State: Zip + 4: <br />20420 681h Avenue West Lynnwood WA 98036 <br />III. On -site Contact Person (Typically the Certified Erosion & Sediment Control Lead or O_ perator/Permittee) <br />Name: <br />l Company: <br />To be determined - publicly bid project <br />Mailing Address: <br />Business Phone: <br />Ext. <br />Cell Phone (Optional) Fax (Optional): City: State: Zip + 4: <br />E-mail: <br />IV. WQWebDMR Electronic Discharge Monitoring Reporting) <br />You must submit monthly discharge monitoring reports using Ecology's WQWebDMR system. To sign up for WQWebDMR, <br />or to register anew site, go to www.ecy.wa..ov/programs/wq(permits/Daris/i)ortal.litml. If you are unable to submit your DMRs <br />electronically, you may contact Ecology to request a waiver. Ecology will generally only grant waiver requests to those permittees <br />without Internet access. Only a permittee or representative, designated in writing, may request access to or a waiver from <br />WQWebDMR. To have the ability to use the system immediately, you must submit the Electronic Signature Agreement with <br />your application. If you have questions on this process, contact Ecology's WQWebDMR staff at WQWebPoital d( ecy.wa.gov or <br />800-633-6193 or 360-407-7097 (local). _ <br />ECY 020-85 (Rev._ 12/14) <br />