21-105174-ADU Letter of Application & Deed Restriction - 01-27-22-V1DEEARTMEV'r OF COMMUNITY DEVELOPMENT
33325 8'h Avenue South
: ,mow �� �� Federal Way, WA 98003-6325
%253-835-2607; Fax 253-835-2609
FederalWay wwwoftyoffederalway.com
RESUBMITTAL INFORMATION
This completed form MUST accompany all resubmittals.
Additional or revised plans or documents for an active project will not be accepted
unless accompanied by this completed form. Changes to drawings must be clouded.
Submitplans by electronic submittal (Document Upload Link or
https.//www. cityoffederalway. com/node/4588)
Project Number: c9 -L - 0 --/ 7- -
Project Name: Rrvcl, '-�n k&L- cs)/ /
Project Address: 00 S' �~e�4 �3
Project Contact:
Phone: 2-06-366- &S Email Lnic
RESUBMITTED ITEMS:
# of Copies I DETAILED Description of Item
Resubmittal Requested by: (Staff Member)
Letter Dated: 1
/
ass
Bulletin #129 — September 24, 2018 Page 1 of 1 kAllandouts\Rasubmittal Information
After recording, please return to:
Community Development Department
33325 8th Avenue South
Federal Way, WA 98003
CITY OF FEDERAL WAY
ACCESSORY DWELLING UNIT
LETTER OF APPLICATION & DEED RESTRICTION
�Y W J_ being first duly sworn, on oath do hereby certify under penalty of
perjury under the laws of the State of Washington:
That Uwe am/are owner of the single-family dwelling unit located at: 360 (p 'S LO 3 4 (4'5 f ', Federal Way,
Washington, p
Parcel #
Property Legal Description: _ Al W - 2 q7 �?
That I have made application and received City of Federal Way land use approval for an accessory dwelling unit
at this location.
That I presently occupy and will continue to occupy one of the two dwelling units at this location as my
principal and permanent residence for six months or more of the calendar year.
That this certification will remain in effect during the period of my ownership of the property unless I record a
certification with the King County Office of Records and Elections that the use the property for an accessory
dwelling unit has been discontinued. _q
gnature of Applicant
State of Washington )
)SS
County of %A j
On this day personally appeared before me #,++-r/Cr tJ 0,`L(S1'A1 to me known to be the
individual described in and who executed the within and foregoing instrument, and acknowledge that he/she signed
the same as his/her free and voluntary act and deed, for the uses and purposes therein mentioned.
'
GIVEN under my hand and official seal on this day of �nv�r �20� -
Notary's signature
'`S M1111,11 ��' Notary's printed name £ [ l f I t C U �`�
��•. EXP o ••'pC� w Notary Public in and for the St e of ashington.
My commission expires / g
NOTARY
an:
P cFa �ying e�occupaney is subjec£ to a civil penalty of $5, 000, in addition to any criminal penalties.
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