Notice is given under SEPA, RCW 43.21C.080, that (name of agency or entity) . . . . . . . . took the action described in (2) below on (date) . . . .

1. Any action to set aside, enjoin, review, or otherwise challenge such action on the grounds of noncompliance with the provisions of chapter 43.21C RCW (State Environmental Policy Act) shall be commenced on or before (date) . . . .

2. Description of agency action: . . . .

. . . .

. . . .

3. Description of proposal (if not covered by (2)):

. . . .

. . . .

4. Location of proposal (a sufficient description should be given to locate the site, if any, but a complete legal description is not required):

. . . .

. . . .

5. Type of environmental review under SEPA (include name and date of any environmental documents):

. . . .

6. Documents may be examined during regular business hours at (location, including room number, if any):

. . . .

7. Name of agency, proponent, or applicant giving notice:

. . . .

8. This notice is filed by (signature of individual and capacity in which the person is signing):

. . . .

. . . .

 

Date . . . .