Fillable Lewis County Community Development (Lewis County)

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Lewis County Community Development (Lewis County)

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File type: PDF

U.S.A. forms for Lewis County

BROWSE LEWIS COUNTY (WA) FORMS

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S:\COMMUNITY DEVELOPMENT\Applications & Forms\Currently on Website
Updated April 2020
APPEAL OF TYPE I OR II ADMINISTRATIVE DECISION
After
an administrative decision is made by Lewis County, the public has the right to appeal based on the Lewis
County Code. The appeal information is listed on the written administrative decision made.
After submitting the petition to appeal, the request will be forwarded to the Lewis County Hearing Examiner. Unless
the petition is dismissed, the Hearing Examiner will hold a hearing in accordance with Lewis County Code 2.25.
The following items are required to be submitted for the Appeal of Administrative Decision application to begin the
process:
STAFF APPLICANT
‘Appeal of Administrative Decision’ form
Copy of written decision being appealed
Application Fees
Appeal fee: $450.00
Legal publication fee: $250.00
Hearing Examiner fee: $750.00
Other:
For Official Use Only:
Date of Received: ________________________________
Application Number:
Associated Permits: Permit Technician:
Date forwarded to Hearing Examiner: _________ / ___________ / ____________
Copy sent to Appeals Coordinator: __________ /__________ /____________Original sent to___________________
Lewis County
Community Development
2025 NE Kresky Ave, Chehalis, WA 98532
Phone: (360) 740-1146 ● Fax: (360) 740-1245
Lewis County Community Development
2025 NE Kresky Ave, Chehalis, WA 98532 Phone: (360) 740-1146 ● Fax: (360) 740-1245
APPEAL OF TYPE I OR II ADMINISTRATIVE DECISION
S:\COMMUNITY DEVELOPMENT\Applications & Forms\Currently on Website
Updated April 2020
Deci
sion Information
Name of Applicant/Owner:____________________________________________________________________
Address: ___________________________________________________________________________________
Tax Parcel Number: ______________________________ Application Number (if applicable): ______________
Phone Number: __________________________ Email: _____________________________________________
Appeal Information
Specific identification of decision being appealed:
SEPA Determination
(Appeal authorized per LCC 17.110.130)
Type I Administrative Decision as identified in LCC 17.05.040(2) Table 17.05-2
(Appeal authorized per LCC 17.05.040(2) Table 17.05-1)
Type II Administrative Decision as identified in LCC 17.05.040(2) Table 17.05-2
(Appeal authorized per LCC 17.05.040(2) Table 17.05-1)
Specific grounds for petition, concise statement of the factual reason for the appeal, and identification of the
policies, statutes, codes or regulations that the petitioner claims are violated (attach additional sheets if
necessary):
Petitioner Information (attach additional sheets if necessary)
Name and address of Petitioner Attorney for Petitioner (if applicable):
___________________________________ ___________________________________
___________________________________ ___________________________________
___________________________________ ___________________________________
___________________________________ ___________________________________
Daytime Telephone: __________________ Daytime Telephone: __________________
Email: ______________________________ Email: ______________________________
___________________________________ ___________________________________
Signature of Petitioner Signature of Attorney
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Lewis County Community Development (Lewis County)

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Completed 21 January 2021

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