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ORIA-revised 02/2020 Page 1 of 15 <br /> <br /> WASHINGTON STATE <br />Joint Aquatic Resources Permit <br />Application (JARPA) Form 1,2 [help] <br />USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW. <br /> <br /> <br /> <br /> <br />Part 1–Project Identification <br />1. Project Name (A name for your project that you create. Examples: Smith’s Dock or Seabrook Lane Development) [help] <br />Flounder Bay Dock Project- 2001 Skyline Way <br /> <br /> <br />Part 2–Applicant <br />The person and/or organization responsible for the project. [help] <br />2a. Name (Last, First, Middle) <br />Cay, Bruce <br />2b. Organization (If applicable) <br /> <br />2c. Mailing Address (Street or PO Box) <br />2001 Skyline Way <br />2d. City, State, Zip <br />Anacortes, WA 98221 <br />2e. Phone (1) 2f. Phone (2) 2g. Fax 2h. E-mail <br />214-783-6975 <br /> <br /> <br /> 1Additional forms may be required for the following permits: <br />• If your project may qualify for Department of the Army authorization through a Regional General Permit (RGP), contact the U.S. Army Corps of <br />Engineers for application information (206) 764-3495. <br />• Not all cities and counties accept the JARPA for their local Shoreline permits. If you need a Shoreline permit, contact the appropriate city or county <br />government to make sure they accept the JARPA. <br /> 2To access an online JARPA form with [help] screens, go to <br /> <br /> <br /> <br />For other help, contact the Governor’s Office for Regulatory Innovation and Assistance at (800) 917-0043 or <br /> <br /> <br /> <br />AGENCY USE ONLY <br /> <br />Date received: <br /> <br />Agency reference #: <br />Tax Parcel #(s): <br /> <br /> <br /> <br />09/14/2021 <br />SDP-2021-0009