Lewis County Community Development
Signature: __________________________________________
Date: ____________________
Check one:
Owner
Authorized Agent
Master Site Plan Application
Appointment Information: Date: ___________________ Time: _____________
For the appointment, you will need:
•Completed 'Master Site Plan Application'
•Site plan that includes all items listed on the 'Site Plan Requirements' handout (attached)
•Associated fees ($200 or $50 depending on the project)
Full Project Description: ___________________________________________________________________________
2025 NE Kresky Ave, Chehalis, WA 98532 ● Phone: (360) 740-1146 ● Fax: (360) 740-1245
Tax Parcel Number (s): ____________________________________________________________________________
Site Address: ____________________________________________________________________________________
Owner’s Name: __________________________________________________________________________________
Owner’s Address: ________________________________________________________________________________
Owner’s Phone Number: __________________ Owner’s Email: __________________________________________
Applicant Information:
Name: _________________________________________________________________________________________
Mailing Address: _________________________________________________________________________________
Phone Number: __________________________ E-mail: ________________________________________________
Acknowledgment
I understand that County regulations require owner permission for County personnel to enter private property to
conduct permit processing, review, and inspections. I also understand that my failure to grant permission to enter may
result in denial or withdrawal of a permit or approval. By my signature below, permission is granted for representatives
of the Community Development, Environmental Services, and Public Works Department to enter and remain on and
about the property for the sole purpose of processing such permits and performing required inspections or reviews.
Prior notification of the date of inspections will take place is:
Required Not Required
(________) ___________________ (Must provide phone number where applicant/representative can be reached)
I/We certify that all plans, specifications and other submissions required in support of this application conform to the
requirements of all federal, state, and local codes and applicable laws and ordinances; and I certify that I am either the
current legal owner of this property or their authorized representative. With this document, I take full responsibility for
the lawful action that this document allows.
I certify that I have read and understand the limitations and conditions of Lewis County Code and agree to comply with
all conditions of approval. I understand that any permits issued by Lewis County, consistent with the attached site plan,
are valid ONLY if construction is in according to this plan and all other conditions of the permit are followed. By my
si
gnature below, I affirm that all the information and documents provided with this application are true and accurate to
the best of my knowledge.
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