Permit register entry form

This form is only for Ecology and other Washington clean air agencies to electronically submit permit register entries.

* required field

* required field

Business applying for permit: *

Physical address: *

City: *

ZIP code: *

Facility description: *

Permit type: *

Permit action: *

Date of agency decision: *

This date is for final decisions. If permit is a draft, use today's date.

Describe permit modification:

Will pollutants be increased with this action: *

Yes No

Year that emissions were reported in emissions inventory (WEIRS):

Ammonia tons per year (TPY):

Carbon monoxide TPY:

Chlorine TPY:

Hydrogen fluoride TPY:

Lead TPY:

Nitrogen oxides TPY:

Ozone TPY:

Particulate matter (PM 2.5) TPY:

Particulate matter (PM 10) TPY:

Particulates, total TPY:

Sulfur dioxide TPY:

Volatile organic compounds (VOCs) TPY:

Other pollutant(s) not listed above TPY:

Public comment period (start date – end date):

example: January 3, 2023 – February 3, 2023

Public comment period *

Yes No

Public hearing: *

Yes No

Clean air agency: *

Agency contact: *

Email: *

Enter your email to receive confirmation.

Re-enter your email: *

Date submitted: *

v.7.27.23