10-102565K
RECEIVE` DEPARTNI ENT OF COMMUNITY DEVELOPMENT SERVICES
,3325 8 h Avenue South
8 2010 PO Box9718
(0-Ty OF Federal Way WA 98063-9718
253-835-2007. Fax 253-S35-2609
WF-[)FRAL'1111y Federa
,�w ww.cityol'fcdcratieay.cont
CDS
FOREST PRACTICES APPLICATION
CLASS IV - GENERAL
TYPE OR PRINT IN INK
1 I nncinwnpr Timber Owner_ and Onerator Information
Le al Name of LANDOWNER
Legal Name of TIMBER
OWNER
Legal Name of OPERATOR
"o,<
f
M ding Ad(#ess:
Mailing Address:
Mailing Address:
I ul -3y t5. 33c) 51'
it , State. Zip
City, State, Zip
City, State, Zip
Phone
Phone ( )
Phone ( )
Email:" v �
Email:
Email:
Contact Person Information
ContacLAIerson k Phone ( d.e.� --I / d S f cwv
a,.3 3 9 4
3. Enter the Applicable City of Federal Way Development Permit Application Number(s)
here: _ o 1� me
4. Enter the Forest Tax Reporting Account Number of the Timber
Owner-
For tax reporting information or to receive a tax number, call the Department of Revenue at 1-800-548-8829.
5. Legal description where the forest practices will occur.
Parcel Number
Within 1/4 section of_
Section
Township
Range
E/W
6. Answer each question as it applies to your proposed forest practice.
( ) No (I Yes Is the activity within the `Natural Environment" as regulated by Federal Way Revised
Code (FWRC) Title 15, "Shoreline Management"?
(p¢ No ( ) Yes Is the activity within 200 feet of an environmentally sensitive area and its associated
buffer area (wetland, stream, wellhead capture area, and/or geologically hazardous area)?
Bulletin #072 — July 7, 2009 Page 2 of 2 k:/Handouts/Forest Practices Application
( ) No (A) Yes Have you reviewed this forest practices activity area to determine whether it may
involve historic sites and/or Native American cultural resources?
7. What is the intended future use of the land proposed to be logged?
( ) Single Family Residence
( ) Residential Subdivision (includes plats and short plats)
( ) CUm1T1CTC181 VF Multi 'amily Residential
() Other
8. How much merchantable timber are you cutting and/or removing?
Complete the table below and indentify all timber harvest and salvage activity boundaries on the site plan.
Unit #
Acres (net)
Volume of Merchantable
Timber to be harvested (board
feet)
Percent (%) of Total
Merchantable Timber on
site.
9. Summarize below the proposed timber harvest method, how the site will be accessed,
and the proposed timing of the timber harvest within the context of the overall project
1 � 1 � 1 /�_ I •Y
ems. -
_ I
We affirm that the information contained herein is true and understand that this proposed forest practice is subject to the
State Forest Practices Act and Rules and FWRC Chapter 19_ I20, `Clearing, Grading, and Tree and Vegetation Retention,"
as well as all other federal, state or local regulations. Compliance with the State Forest Practices Act and Rules and FWRC
Chapter 19.120 does not ensure compliance with the Endangered Species Act or other federal, state, or local laws.
Signature of LANDOWNER
Signature of TIMBER OWNER
Signature of OP RATOR
(If different than la ndow•ncr)
(if ii'ffercnt than ielo �n
Print Name:
Print Name:
Priaet N� mc:
V/Af
Date:
Date:
Date:
Dopartm oitol Revenuc Nolilicd (dale
Date Approved:
Cotuiiien [�1C'c end i t.iott s:
Bulletin #072 — July 7, 2009
Department Review
WOr 01'licc- Lise Only)
Page 3 of 2 k:/Handouts/Forest Practices Application
J
us Li
�