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Shoreline permit data form

This shoreline permit data form is used as a cover sheet for local shoreline permits filed with the Department of Ecology. The information in the form is entered into a statewide database.

The data sheet is required by state rule. The rule is found in Chapter 173-27 WAC "Shoreline Management Permit and Enforcement Procedures, Part I: Permits for development on shorelines of the state" under sections 130 and 190.  The form is referenced as Appendix A.

Download permit data sheet

• PDF version (best for printing blank version). Note: To view and/or print PDF files, you may need to download and install Adobe Acrobat Reader from this link.
• MS Word version. Note: To use, save this file to your computer, open in Microsoft Word, use the Tab key to move through fields.

For more information

Contact Ecology's regional office permit reviewer if you have questions about this data sheet.