Lewis County Community Development
Signature: __________________________________________
Date: ____________________
Check one: Own
er
Authorized Agent
Airport Obstruction Zone Application
If your Master Site Review determined an Airport Obstruction Zone Permit is required, the following is required to be
submitted with the building permit application:
• Completed 'Airport Obstruction Zone Application'
• Approved Master Site Review and approved site plan
• Federal Aviation Administration (FAA) Part 77 Approval. For the FAA review, you will need to file the FAA
Form 7460-1, Notice of Proposed Construction or Alteration. Use the following link for instructions and
additional information: https://oeaaa.faa.gov/oeaaa/external/content/efilerGuide.jsp
• Associated fees ($90)
2025 NE Kresky Ave, Chehalis, WA 98532 ● Phone: (360) 740-1146 ● Fax: (360) 740-1245
Full Project Description: ___________________________________________________________________________
Tax Parcel Number (s): ____________________________________________________________________________
Site Address: ____________________________________________________________________________________
Owner’s Name: __________________________________________________________________________________
Owner’s Address: ________________________________________________________________________________
Owner’s Phone Number: __________________ Owner’s Email: __________________________________________
Applicant Information:
Name: _________________________________________________________________________________________
Mailing Address: _________________________________________________________________________________
Phone Number: __________________________ E-mail: ________________________________________________
Site Information:
Airport: ☐ Ed Carlson Memorial Field (Toledo)
☐ Packwood Airport
AOZ: ☐ Visual Runway Visual Approach Zone
☐ Transitional Zone
☐ Horizontal Zone
☐ Conical Zone
☐ Primary Surface
Acknowledgment
I certify that all plans, specifications and other submissions required in support of this application conform to the
requirements of all federal, state, and local codes and applicable laws and ordinances; and I certify that I am either the
current legal owner of this property or their authorized representative. With this document, I take full responsibility for
the lawful action that this document allows.
I certify that I have read and understand the limitations and conditions of Lewis County Code and agree to comply with
all conditions of approval. I understand that any permits issued by Lewis County, consistent with the attached site plan,
are valid ONLY if construction is in according to this plan and all other conditions of the permit are followed. By my
signature below, I affirm that all the information and documents provided with this application are true and accurate
to the best of my knowledge.
S:\COMMUNITY DEVELOPMENT\Applications & Forms\Currently on Website
Elevation: __________
Structure Height: __________
Latitude: ______°______’ _______”
Longitude: ______°______’ _______”
Link to map for assistance:
https://maps.lewiscountywa.gov/
