CITY OF DES MOINES SHORELINE MASTER PROGRAM

Des Moines Shoreline Master Program
Shoreline Management Act
Permit Data Sheet and Transmittal Letter
(WAC 173-27-990)
From: (local government) To: (appropriate Ecology office)
Date of Transmittal: Date of Receipt: (provided by Ecology)
Type of Permit: (Indicate all that apply)
Substantial Development ; Conditional Use ; Variance ; Revision ; Other .
Local Government Decision: Approval ; Conditional Approval ; Denial :
Applicant Information:
Name:
Applicant's Representative: (if primary contact)
Name:
Address:
Address:
Phone(s):
Phone(s):
Is the applicant the property owner? yes no
Location of the Property: (Section Township and Range to the nearest 1/4, 1/4 Section or latitude and longitude, and a street address where available)
Water Body Name:
Shoreline of Statewide Significance: Yes No .
Environment Designation:
Description of the Project: (Summary of the intended use or project purpose)
Notice of Application Date:
By: (Local Government Primary Contact on this Application)
Phone No:
Final Decision Date:
Department of Ecology approval effective November 1, 2010
Adopted by City of Des Moines Ordinance No. 1502 111