16-103169-AUReturn Address:
:
I201609070 0698
P or
KING COUNV WA
Please print or type information WASHINGTON STATE RECORDER'S Cover Sheet (Pcw
Document Title($) (or transactions contained therein)
1. L°i o. REA- e k L PLY �1[.�sar-Y 2. _
(all areas applicable to your document must be filled in)
3. cep p l i c o-n 6.rc4. Cl-�
Reference Number(s) of Documents assigned or released:
Additional reference #'s on page of document
Grantor(s) Exactly as name(s) appear on document
L
2.
Additional names on page of document.
Grantee(s) Exactly as name(s) appear on document
1. �' c
2.
Additional names on page of document.
Legal description (abbreviated: i.e. lot, block, plat or section, township, range)
V-Civ L CC3 37L -) 20
-7 b �'' �!C cy'•S I-c� ( Ly�<e.
Additional legal is on page of document.
Assessor's Property Tax Parcel/Account Number ❑ Assessor Tax # not yet
assigned � :5-7 6l) - b 3 I Q- D d
The Auditor/Recorder will rely on the information provided on this form. The staff will not read the document
to verif the aceurac or cam leteness of the indexing information provided herein.
"I am signing below and paying an additional $50 recording fee (as provided in RCW 36.18.010 and
referred to as an emergency nonstandard document), because this document does not meet margin and
formatting requirements. Furthermore, I hereby understand that the recording process may cover up or
otherwise obscure some part of the text of the original document as a result of this request."
Signature of Requesting Party
Note to submitter: Do not sign above nor pay additional $50 fee if the document meets margiulformatting requirements
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
Carol ceec;s
I, Mao-Wo R • er'e 5 S being first duly sworn, on oath do hereby certify under penalty of
perjury under the laws of the State of Washington:
That we am/are owner of the single-family dwelling unit located at: _ a 0 3 5 s ` �d�� � � � - 1: L 0&:= -' r6 L s� W*/
Federal Way, Washington, 9aa�
Parcel # U ri 5700 — 6 3449 — Q D
Property Legal
S -4- `7,
e- r& 5f'ee/ Ie2ke- r?
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 of the property for an accessory
dwelling unit has been discontinued.
Signature of Applicant
State of Washington)
)ss.
County of )
On this day personally appeared before me 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 , 20_
Notary's signature
Notary's printed name
Notary Public in and for the State of Washington.
My commission expires
Falsely certifying owner occupancy is subject to a civil penalty of $5,000, in addition to any criminal penalties.
CALIFORNIA ALL- PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity
of the individual who signed the document to which this certificate is attached,
and not the truthfulness, accuracy, or validity of that document.
State of California
County of Riverside }
y� �f I.2ZOn 7 before me, I'I�
(Z� f�
g
name an u e o the icer)
personally appearedCQV61 H. r�� Q.V7� V1 60
who proved to me on the basis of satisfactory evidence to be the person(s) whose
name(s),V/are subscribed to the within instrument and acknowledged to me that
�We/they executed the same in,bTsl�r/their authorized capacity(ies), and that by
his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of
which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
KIMBERLY MARTINEZ
WITNESS my hand and official seal. COMM.02026089 a
NOTARY PUBLIC - CALIFORNIA
j E# RNECOUNTY
COIIMII. E1�IfeS JUlle 21, 2017
Notary
w--
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
Le kir of P
Ic�h�
(Titleorderptionofattach doc t)� Cal 5
(Title or description of attached document continued)
Number of Pages! Document Date
CAPACITY CLAIMED BY THE SIGNER
❑ Individual (s)
❑ Corporate Officer
(I ltie)
❑ Partner(s)
❑ Attorney -in -Fact
❑ Trustee(s)
❑ Other
2o'i �tCi Sl��il WP rrd.i��Ol�ry�Cl£SSe5.001i1 3 Ci ._,.
Public Seal)
INSTRUCTIONS FOR COMPLETING THIS FORM.
This form complies with current California statutes regarding rtotmy wording and,
if needed, should be completed and attached to the doctunent. Acknowledgments
front other states may be completed for documents being sett to that state so long
as the wording does not require the California notmy to violate Calrjornia notary
larv.
• State and County information must be the State and County where the document
signer(s) personally appeared before the notary public for acknowledgment
• Date of notarization must be the date that the signer(s) personally appeared which
must also be the same date; the acknowledgment is completed.
• The notary public must print his or her name as it appears within his or her
commission followed by a comma and then your title (notary public),
• Print the name(s) of document signer(s) who personally appear at the time of
notarization,
• Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.
he/she/they,- is /are) or circling the correct forms. Failure to correctly indicate this
information may lead to rejection of document recording,
• The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges, re -seal if a
sufficient area permits, otherwise complete a different acknowledgment Form,
• Signature of the notary public must match the signature on file with the office of
the county clerk.
Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
Indicate title or type of attached document, number of pages and date.
Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer, indicate the title (i.e, CEO, CPO, Secretary).
• Securely attach this document to the signed document with a staple.
IiECENED
DEPARTMENT OF COMMUNITY DEVELOPMENT
_ JUN Q 2016 33325 81h Avenue South
Federal Way, WA 98003
CITY OF 253-835-2607; Fax 253-835-2609
C.1 i�' OF FEDERAL WAY www.citvofcedgM1AVy.com
Federal Way CDS
ACCESSORY DWELLING UNIT (ADU)
FEE: Contact the Permit Center at 253-835-2607, or ermitcenter ci offederalwa .eom
FILE # Yam' % "' 1 RELATED FILE #S:
Owner's Name: t.l0�a 1�y� "N ci s) �
-1-t _ _ .....f - a r 9 _ n .. . A . C% i ■
Daytime Phoonep? 3 Tax Parcel#:0
Zoning: PS -7. Z Lot Size in Square Feet: &G Poo V
Type of ADU: ❑ Attached Detached Is this a: X New ADU ❑ Existing ADU
Existing ADU was: ❑ Approved by King County (Provide a copy of the permit.) ❑ Other
Construction of existing ADU completed in 19__/20_
Construction of existing residence completed in 19_/20
Which is the owner occupied unit: Primary Dwelling Unit or ❑ ADU
Number of square feet: 1400 Primary Dwelling Unit ADU
Provide the following information:
VL10 akehaven Utility District Water & Sewer Certificates of Approval for the New ADU
❑ King County Publics Health Department Approval (if septic)
❑ Heating Type: Vf iectric ❑ Gas ❑ Other
❑ Electrical Capacity: Primary Dwelling Unit
IR/Letter of Application & Deed Restriction (attach)
ADU FLOOR PLAN DRAWINGS (Provide the following; refer to page 3 for an example.)
Yo`Floor plan of the primary dwelling unit and the ADU
P Plumbing (existing & proposed)
❑ echanical — HeatingNentilation/Air Conditioning (existing & proposed)
Vtrances of primary dwelling unit and ADU (existing & proposed) fling Heights/Room Sizes for ADU
of the proposed ADU with the primary dwelling unit
ADU
Bulletin #049 — December 21, 2015 Page 1 of 3 k:\Ilandouts\ADU Application
ADU SITE PLAN DRAWINGS (Provide the following; refer to page 3 for an example.)
V Scale/north arrow 2Street/driveway location
V Lot dimensions U"Primary dwelling unit
P( ADU footprint (if detached) Building setbacks from property line
❑ Location of utilities & easements
Show location of three on -site parking stalls
(Locate the entrance of the primary dwelling unit and the ADU
❑ Calculate the total impervious surfaces coverage for the site (Include the existing and proposed roof area,
driveway, patios, and walkways.)
❑ Other
DISCLAIMER: I certify under penalty of perjury that the information furnished by me is true and
correct to the best of my knowledge and, further, that I am authorized by the owner of the above
premises to perform the work for which the permit application is made.
c
M6POI
Signature of Applicant Date
WAIVER: Approval of the ADULand Use Application does not constitute approval of the building permit.
Application and approval of the building permit is a separate process.
OFFICE USE ONLY
❑ ADU Status: ❑ LegaI Nonconforming per FWRC 19.30.140 New ADU
�of�:Ab'U
1 Deed Restriction/Letter of Application Rec'd T�j Recording Number ? U(O VVJ DCi/ a c—,
❑ Other ee -# 1 — 5 F 5 t t r
Approved by Dated
❑ Conditions of Approval No iNe
Bulletin #049 — December 21, 2015
Page 2 of 3
k:\HandoutsWDU Application
Becky Chapin
From: Becky Chapin
Sent: Tuesday, August 02, 2016 2:37 PM
To: 'dolson3287@aol.com'
Subject: Cross ADU
Attachments: ADU Restriction.pdf, Example ADU.pdf
Hi Dave,
The Planning Department has finally reviewed the Accessory Dwelling Unit (ADU) located at 2035 S 308th Street, Federal Way.
Everything looks good as far as the ADU itself goes. However, the site plan that you submitted does not clearly show three parking
spaces. On your resubmittal for the building permit, please clearly depict the location of the parking spaces and make sure that the
main residence has two parking spaces and the ADU has one, as required per Federal Way Revised Code (FWRC)19.200.010 and
19.200.180. Please refer to the example in the ADU handout, which clearly shows three cars.
Also, the department has not received the letter of application/deed restriction stating that the owner(s) shall occupy one of the dwelling
units on the premises for six months or more of the calendar year. Prior to the final building inspection/Certificate of Occupancy of the
new ADU, the owner is responsible for recording the Letter of Application & Deed Restriction (attached) with King County Recorder's
Office. Once recorded, please provide the City with a copy of the recorded ADU restriction document. The ADU restriction will remain
recorded against the property.
Once I get verification of the parking spaces I can proceed with approval of the ADU application. If you have any questions please feel
free to contact me.
Best,
Becky Chapin
Associate Planner
Federal Way
33325 8th Avenue South
Federal Way, WA 98003-6325
Phone:253-835-2641 Fax: 253-835-2609
www.cityoffederalway.com
RECEIVED
JUN 3 0 2016
CITY OF FEDERAL WAY
CDS
1
aC)95 s. 36e�jNr 5-r,
RECEIVED
*nis
JUN 3 0 2016 wn
11��ICITY OF FEDERAL WAY �r
CDS r
Lakehaven Utility District - Development Engineering Section M
31623 - 1st Ave S * PO Box 4249 * Federal Way, WA 98063-4249
Telephone: 253-945-1581 or 253-945-1580 * Email: DE@Lakehaven.org
This certificate is intended to provide the applicant, land'use agencies &/or public health departments with
information necessary to evaluate development proposals. Lakehaven Utility District, at its sole discretion,
reserves the right to delay, or deny, water service based upon capacity &/or supply limitations in
Lakehaven's or Other Purveyor's system facilities.
Proposed Land Use
® Building Permit-SFR
❑ Subdivision
❑ Rezone
❑ Other (specify/describe'
Tax Parcel Number(s): 0537000390
Ex. Bldg. Area to Remain: UNKNOWN sf
Applicant's Name: Dave Olson
WATER SYSTEM INFORMATION
❑ Building Permit-MFR ❑ Building Permit -Other
❑ Short Subdivision ❑ Binding Site Plan
❑ Boundary Line Adjustment
Site Address: 2035 S 308th St Lakehaven Grid: K-07
New Bldg. Area Proposed: UNKNOWN sf
1. ® Water service can be provided by service connection to an existing 8" diameter water main that is approximately 15+ - feet
from the site.
2. ❑
Water service for the site will require an improvement to Lakehaven's water distribution system of:
❑
a.
feet of " diameter water main to reach the site; and/or
❑
b.
The construction of a water distribution system on the site; and/or
❑
c.
A major portion of Lakehaven's comprehensive water system plan would need to be implemented and/or
constructed; and/or
❑
d.
Other (describe):
3. ®
a.
The existing water system is in conformance with Lakehaven's Comprehensive Water System Plan.
❑
b.
The existing water system is not in conformance with Lakehaven's Comprehensive Water System Plan and an
Amendment to this Plan will be required. This may cause a delay in issuance of land use approvals or permits.
4. ®
a.
The subject property is within the corporate limits of Lakehaven Utility District, or has been granted
Boundary Review Board approval for extension of water service outside of Lakehaven's water service area.
❑
b.
Annexation or Boundary Review Board approval will be necessary to provide service.
S. Water
service is subject to:
®
a.
Payment of connection charges (to be determined by Lakehaven);
❑
b.
Proof or reservation of easement(s) as required by Lakehaven;
®
c.
Other: The existin 4" meter negds to be evaluated under UPC to determine if it's adequate for the
proposed use. Water Service on Ion I cati uir d for ifi a ion exis In nice annection er r
additional service connection/meter.
Comments/special conditions:
The nearest fire hydrant is approximately 245+ - feet from the Property (as shown on map on the back of this page).
Fire Flow at no less than 20 psi available within the water distribution system is 2 800+ - gpm (approximate) for two (2) hours or
more. This flow figure depicts the theoretical performance of the water distribution system under high demand conditions. Hydraulic
model results (FF #270) indicate that Lakehaven's standard maximum allowable velocity of 10 ft/s is exceeded at a fire flow rate
above 2 800+ - gpm. Fire flow rates greater than this may be accommodated through water distribution system improvements,
contact Lakehaven for additional information.
578 Pressure Zone Property Elevations (GIS): High 490+/-, Low 475+/- Est. Pressures (psi): Min. 35, Max. 50
I hereby certify that the above water system information is true. This certification shall be valid for one (1) year from the date of
signature.
Name: BRIAN ASBURY Title: DEVELOPMENT ENGINEERING SUPERVISOR
Signature:
Date: • 30�
Olson wtr 0537000390.docx (2/22/16) Page 1 of 2
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Olson wtr 0537000390.docx (2/22/16) Page 2 of 2
RECEIVED
JUN 3 0 2016
CITY OF FEDERAL WAY
"111TY DIS'WL'� CDs
Lakehaven Utility District - Development Engineering Section
31623 - 1st Ave S * PO Box 4249 * Federal Way, WA 98063-4249
Telephone: 253-945-1581 or 253-945-1580 * Email: DE@Lakehaven.org
"n
m
This certificate is intended to provide the applicant, land use agencies &/or public health departments with
information necessary to evaluate development proposals. Lakehaven Utility District, at its sole discretion,
reserves the right to delay, or deny, sewer service based upon capacity &/or supply limitations in
Lakehaven's or Other Purveyor's system facilities.
Proposed Land Use: ® Building Permit-SFR ❑ Building Permit-MFR ❑ Building Permit -Other
❑ Subdivision ❑ Short Subdivision ❑ Binding Site Plan
❑ Rezone ❑ Boundary Line Adjustment
❑ Other (specify/describe)
Tax Parcel Number(s): 0537000390 Site Address: 2035 S 308th St Lakehaven Grid: K-07
Ex. Bldg. Area to Remain: UNKNOWN sf New Bldg. Area Proposed: UNKNOWN sf
Applicant's Name: Dave Olson
SEWER SYSTEM INFORMATION
1. ® Sewer service can be provided by service connection to an existing 8" diameter sewer main that is approximately 30+ - feet
from the site and the sewer system has the capacity to serve the proposed land use.
2. ❑ Sewer service for the site will require an improvement to Lakehaven's sanitary sewer system of:
❑ a. feet of " diameter sewer main or trunk to reach the site; and/or
❑ b. The construction of a sanitary sewer collection system on the site; and/or
❑ c. A major portion of Lakehaven's comprehensive wastewater system plan would need to be implemented and/or
constructed; and/or
❑ d. Other (describe):
3. ® a. The existing sewer system is in conformance with Lakehaven's Comprehensive Wastewater System Plan.
❑ b. The existing sewer system is not in conformance with Lakehaven's Comprehensive Wastewater System Plan and an
Amendment to this Plan will be required. This may cause a delay in issuance of land use approvals or permits.
4. ® a. The proposed site land use is within the corporate limits of Lakehaven Utility District, or has been granted
Boundary Review Board approval for extension of sewer service outside of Lakehaven's sewer service area.
❑ b. Annexation or Boundary Review Board approval will be necessary to provide service.
S. Sewer service is subject to:
® a. Payment of connection charges (to be determined by Lakehaven);
❑ b. Proof or reservation of easement(s) as required by Lakehaven;
® c. Other: Sewer -Service Connection Permlt required.
Comments/special conditions: The existing re ldence Is currentlyconngcted to sewer SSCP 6077).
I hereby certify that the above sewer system information is true. This certification shall be valid for one (1) year from the date of
signature.
Name: BRIAN ASBURY Title: DEVELOPMENT ENGINEERING SUPERVI50R
Signature: {� Date:
Olson swr 0537000390.docx (2/22/16) Page 1 of 2
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Olson swr 0537000390.docx (2/22/16) Page 2 of 2
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