HomeMy WebLinkAboutCertComp-v20210831.pdfCERTIFICATE OF COMPLIANCE
WITH DEPARTMENT OF THE ARMY PERMIT
NWS- Permit Number:
Name of Permittee:
Date of Issuance:
Upon completion of the activity authorized by this permit, please check the applicable boxes below, date
and sign this certification, and return it to the following email or mailing address:
Department of the Army
U.S. Army Corps of Engineers Seattle
District, Regulatory Branch
4735 E. Marginal Way S, Bldg 1202
Seattle, Washington 98134-2388
Please note that your permitted activity is subject to a compliance inspection by a U.S. Army Corps of
Engineers representative. If you fail to comply with the terms and conditions of your authorization, your
permit may be subject to suspension, modification, or revocation.
The work authorized by the above-referenced permit has been completed in accordance with the terms
and conditions of this permit.
Date work complete: __________________________________
Photographs and as-built drawings of the authorized work (OPTIONAL, unless required as a
Special Condition of the permit).
If applicable, the mitigation required (e.g., construction and plantings) in the above-referenced permit has
been completed in accordance with the terms and conditions of this permit (not including future
monitoring).
Date work complete: __________________________________N/A
Photographs and as-built drawings of the mitigation (OPTIONAL, unless required as a
Special Condition of the permit).
Provide phone number/email for scheduling site visits (must have legal authority to grant property access).
Printed Name: ____________________________________________________________________________
Phone Number: _____________________________ Email: ____________________________________
Printed Name:
Signature:
Date:
NWS.Compliance@usace.army.mil OR