Fillable to Cross Tulalip Tidelands (The Tulalip Tribes)

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to Cross Tulalip Tidelands (The Tulalip Tribes)

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The Tulalip Tribes
Community Development
6406 Marine DR NW
Tulalip, WA 98271
Telephone: (360) 716-4210
PAYMENT SUMMARY
FEE
The applicant is required to provide a proof of the surety such as bond,
insurance, or other surety representing a minimum of 125% of the value of
the work (prior to submitting the application), mitigation report, survey, etc.
Make check payable to:
The Tulalip Tribes
APPLICATION FEE
(non-refundable)
$ 300.00
TOTAL AMOUNT PAID
$
This is an application for a revocable license to cross Tulalip Tidelands for construction as authorized in Tulalip Title 8 #8.30,
section8.30.020.3.e. By signing below, the applicant acknowledges that this license is revocable at will and in the sole
discretion of the Tulalip Tribes, and nothing in any revocable license issued by the Tulalip Tribes creates any property rights for
any person, or conveys any property rights of the Tulalip Tribes in any manner whatsoever.
Authorization to be issued to:
Date of Application
Home Address (Street or Route, P.O. BOX)
Telephone Number
( ) -
City, State, Zip
Fax Number
( ) -
Applicant’s Representative:
Telephone Number
( ) -
Home Address (Street or Route, P.O. BOX)
Fax Number
( ) -
City, State, Zip
IMPORTANT PLEASE NOTE:
NO WORK CAN BE STARTED ON THE PROJECT AREA UNTIL the applicant has complied with all requirements in Title 8
#8.30 and revocable license to cross tribal tidelands for construction has been issued to the applicant under the authority of the
Tulalip Board of Directors.
LOCATION:
Physical description of Project Area (For example, Marsh, Tideflat adjacent to Ebey Slough Creek, etc.):
Name of Owner(s) of Uplands, Shorelands, and/or Tidelands shoreward:
Telephone Number
( ) -
( ) -
Home Address (Street or Route, P.O. BOX
City, State, Zip
Legal Description of Property (Section, Township, Range): Please attach complete description.
Application Number
OWNER/ (Please print clearly)
Application for Revocable License
to Cross Tulalip Tidelands
Please type or print clearly in dark ink.
D
A
B
C
Application for Revocable License
to Cross Tulalip Tidelands
Revised 03/2014
1 of 4
Upland Site Acreage:
Present use of the Upland Property:
USE OF TRIBAL TIDELANDS: Type of proposed use of Tribal Tidelands and identify additional proposed use, if any.
1. Physical description of Corridor Area (For example: Tidelands at Mission Beach, Marsh, Tideflat adjacent to Ebey Slough Creek, etc.)
2. Type of physical improvements or structures that currently exist on the shoreline above Tribal Tidelands.
3. If there are physical improvements currently on the shoreline, who holds ownership to them?
4. If there are physical improvements currently on the shoreline, describe their condition.
5. Which of the existing physical improvements will be removed, remodeled, or reconstructed?
6. Type of physical improvements or structures that you are proposing to construct on the shoreline above Tribal Tidelands.
7. Value of proposed improvements or structures:
$
8. Who will ultimately be served or benefit from this project?
9. Proposed construction starting date:
Completion date:
10. Length of time requested for access to Tribal Tidelands.
11. Length and width of the work corridor area.
E
Application for Revocable License
to Cross Tulalip Tidelands
Revised 03/2014
2 of 4
12. Boundaries of site disturbance: (Show the limits of disturbance on the beach that will be created by equipment operations and
storage, including barge, material stockpiles, wood piling removal and debris stockpiles, etc.)
13. Supplemental documents (provide copies of county assessors information relating to parcel numbers, a legal survey plat of the
construction site and work corridor areas, eng
ineering drawings, site plan of work corridor areas, photos, copies of all government
regulatory permits (County Shoreline Permit, HPA, SEPA, etc.)
14. Detail the construction practice, procedure, stockpiling of materials, and proposed location of the excavation materials, vehicles,
and equipments during low tides with erosion and sediment control. You may use the questions a – h as a guideline:
a. How will the heavy equipment and materials be transported to the construction site?
b. How much volume of heavy materials will be hauled to the site?
c. How will the excess materials be relocated off site?
d. How many current wood pilings are to be removed?
e. How many total linear feet of current wood pilings are to be removed:
f. How will the current wood pilings be removed? (Detail the method of removal and the disposal of wood pilings that will be removed)
g. Will there be any large organic debris and rocks placed on Tribal Tidelands while the structure (i.e. bulkhead pilings) is under
construction?
h. Do you have any knowledge of contamination of the site by toxic or hazardous substances? If so, please explain.
15. Describe any habitat mitigation and identify where such mitigation is proposed to occur.
Application for Revocable License
to Cross Tulalip Tidelands
Revised 03/2014
3 of 4
SIGNATURE: This application may be rejected at any time before signed execution of a use authorization.
I hereby certify that I have prepared this application and site plan and that to the best of my knowledge the information
provided is complete, accurate, and a true representation of the proposed development. I further attest
that I have the
authority to submit this application and agree to comply with any and all conditions of development permit approval. I agree
to provide any additional information required and understand that if the scope of the project is modified, a new application
may be required.
Signature(s) required
X
Title
Date
X
Title
Date
X
Title
Date
Application prepared by (please print)
Title
Telephone Number
( ) -
Date
Staff Notes:
F
Application for Revocable License
to Cross Tulalip Tidelands
Revised 03/2014
4 of 4
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Completed 20 July 2020

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