Lewis County Community Development
2025 NE Kresky Ave, Chehalis, WA 98532 ● Phone: (360) 740-1146 ● Fax: (360) 740-1245
FLOOD DEVELOPMENT PERMIT APPLICATION
NOTE: This application may be used only for projects and/or sites NOT located within shoreline jurisdiction. Any project requiring a Shoreline Permit (Exemption,
Substantial Development, or Conditional Use) must utilize the current Washington State Joint Aquatic Resources Permit (JARPA) Form.
Associated Application #(s) ______________________________________________ Permit Number: __________________
Property Information:
Tax Parcel Number: Site Address:
Owner’s Name: Phone Number:
Owner’s Mailing Address: Email:
Applicant Information (if different) Owner Contractor Other: _________________
Name: Phone Number:
Mailing Address: Email:
Project Information:
Project Description:________________________________________________________________________________________
List all waterbodies:_____________________________________________________________________________________
Existing site conditions (briefly describe how the property is currently being used)
________________________________________________________________________________________________________
Adjacent properties (briefly describe how adjacent properties are currently being used)
________________________________________________________________________________________________________
Signature:
___________________________ Date:__________
Check one: Owner
Authorized Agent
FEMA FIRM Community Panel # 530102-_______________ Floodway on property? Yes No
Pre-Elevation Certificate Submitted Yes No Conditions?___________________________________________
Floodway Zone A (100 yr) Zone X____ /Base elevation or depth # at the development site_______ ft
Alteration to Waterway Flood Fringe Outside Studied Area Substantial Improvement
Certification Required? Yes No Flood Proofing Elevated Housing
Pre-Construction ____________________ Post Construction _______________________
Notes/Conditions of permit:
Building Official’s Signature:____________________________ Date Signed:_______________
2007 Flood Sensitive or NWI Wetland
S:\COMMUNITY DEVELOPMENT\Applications & Forms\Currently on Website
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