15-102108Le E
When Recorded Mail To:
CITY OF FEDERAL WAY CONFORMED COPY
33325 8th Ave S
FEDERAL WAY, WA 98003-6325
ATTN: Kevin Peterson, Public Works Dep't. 20160502000399
FEDERAL WAY GI LLE 77.0e
PACE-001 OF 005
05/02/2016 13'43
LOT LINE ELIMINATION AND RESTRICTIVE COVENANT
Grantee(s): WAS14INGTON CVS PHARMACY, LLC, a Washington limited liability company
Grantoe(s): CITY OF FEDERAL WAY, a Washington municipal corporation
Parcel A Legal Description (abbreviated): Pcl. B of City of Federal Way BLA92-0020, REC. #
9303039002
Complete Legal Description indicated below.
Parcel B Legal Description (abbreviated): Pcl. C of City of Federal Way BLA92-0020, REC. #
9303039002
Complete Legal Description indicated below
Assessor's Tax Parcel ID#(s): 132103-9098, 132103-9099
A. The undersigned party(s) is the owner(s) ("Property Owner") of certain real properties
located in Federal Way, Washington, and legally described as follows:
Existing Parcel "A"
Tax Parcel 132103-9099
Parcel B of City of Federal Way Boundary Line Adjustment Number BLA92-0020, as per
the survey thereof recorded under Recording Number 9303039002, in King County,,
Washington;
Except the West 10 feet of Parcel B conveyed to the City of Federal Way by deed recorded
under Recording Number 9809110095.
(Described in Exhibit A and depicted in Exhibit A-1 herewith attached and made a part hereof),
Existing Parcel "B"
Tax Parcel 132103-9098
Parcel C of City of Federal Way Boundary Line Adjustment Number BLA92-0020, as per
the survey thereof recorded under Recording Number 9303039002, in King County,
Washington;
And except that portion of said parcel C conveyed to the City of Federal Way by deed
recorded under Recording Number 20130222001734.
(Described in Exhibit A and depicted in Exhibit A-1 herewith attached and rnade a part hereof),
("Properties").
B. All structures on the Properties and all distances from all structures to Property lines
are set forth in the drawing attached as Exhibit A and incorporated by reference; and
C. Section 58.17.040(5) of the Revised Code of Washington allows the adjustment and
alteration of lot lines between contiguous properties;
NOW, THEREFORE, the Property Owner, in consideration of the mutual benefits to the
foregoing Properties, agrees as follows:
1. Elimination of Lot Line. The Properties shall be combined to become one (1) lot, the
common lot line(s) of the Properties shall be eliminated as set forth in Exhibit A, and the combined lot
shall be legally described as follows:
New Parcel
Parcels B and C of City of Federal Way Boundary mine Adjustment Number 8LA92-
0020, as per the survey thereof recorded under Recording plumber 9303039002, in
King County, Washington;
Except the West 10 feet of Parcel B conveyed to the City of Federal Way by deed
recorded under Recording Number 9809110095;
And except that portion of said parcel C conveyed to the City of Federal Way by deed
recorded under Recording Number20130222001734
(Described in Exhibit A and depicted in Exhibit A-1 herewith attached and made a part hereof),
2. Restrictive Covenant. Upon recordation of this Lot Line Elimination and upon any
subsequent improvement to the Properties, the Property Owner acknowledges that the Properties are
no longer separate lots and accordingly- cannot be individually assigned, transferred or conveyed to
any party or entity, unless in compliance with all applicable federal, state and local laws, regulations,
codes and rules, including, without limitation, all subdivision requirements. This Lot Line Elimination
shall not eliminate, remove or impact in any manner any easements, encroachments or other
restrictions of records.
3. —Binding Effect. This Lot Line Elimination and Restrictive Covenant shall run with the
land, touch and concern the land, and be binding upon and inure to the benefit of the Property Owner's
successors in interest, heirs amend assigns.
DATED this S{,� day of r1 20�
Signature page follows
Cheryl A. G en, Assistant Secretary
Washington CVS Pharmacy, LLC
A
STATE OF � � �d
) ss.
COUNTY OF )
On this day personally appeared before me Cheryl A. Green, to me known to be the Assistant
Secretary of Washington CV5 Pharmacy, LLC that executed the foregoing instrument, and
acknowledged the said instrument to be the free and voluntary act and deed of said limited liability
company, for the uses and purposes therein mentioned, and on oath stated that he/she was authorized
to execute said instrument.
GIVEN my hand and official seal this G_ day ofr 20L'
(typegprinted narnti of notary)
Notary Public in and for the State of
My commission expires
Mary Alice Kleiber
Notary Public
State of Rhode Island
My corns-nissiort Expires 03J13J2020
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EXHIBIT "A"
LEGAL DESCRIPTIONS
ORIGINAL LOTS:
PARCEL 8 OF CITY OF FEDERAL WAY BOUNDARY LINE ADJUSTMENT NUMBER
SLA92-0020, AS PER THE S€RVEY THEREOF RECORDED UNDER RECORDING
NUMBER 9303039002, IN KING COUNTY, WASHINGTON;
EXCEPT THE WEST 10 FEET OF PARCEL 9 CONVEYED TO THE CITY OF
FEDERAL WAY BY DEED RECORDED UNDER RECORDING NUMBER 9809110095.
PARCEL C'OF CITY OF FEDERAL WAY BOUNDARY LINE ADJUSTMENT NUMBER
BLA92-0020, AS PER THE SURVEY THEREOF RECORDED UNDER RECORDING
NUMBER 93030390021 IN KING COUNTY, WASHINGTON;
AND EXCEPT THAT PORTION OF SAID PARCEL C CONVEYED TO THE CITY OF
FEDERAL WAY BY DEED RECORDED UNDER RECORDING NUMBER
20130222001734.
NEW PARCEL:
PARCELS 8 AND C OF CITY OF FEDERAL WAY BOUNDARY LINE ADJUSTMENT
NUMBER BLA92-0020, AS PER THE SURVEY THEREOF RECORDED UNDER
RECORDING NUMBER 9303039002, IN KING COUNTY, WASHINGTON;
EXCEPT THE WEST 10 FEET OF PARCEL B CONVEYED TO THE CITY OF
FEDERAL WAY BY DEED RECORDED UNDER RECORDING NUMBER 9809110095;
AND EXCEPT THAT PORTION OF SAID PARCEL C CONVEYED? TO THE CITY OF
FEDERAL WAY BY DEED RECORDED UNDER RECORDING NUMBER
7C11.3(]979f101734,
SCALE.- For:
HORIZONTAL 1 "=60' VERTICAL N/A
18215 72ND AVENUE SOUTH
H��+'�' KENT, WA 98032
�425 251-6222
425)251•-8782 FAX Title:
Sy hCIVIL ENGINEERING, LAND
PLANNING, ,
'��rclsts�� ENVIRONMENTAL SEIRVICES
GVS PHARMACY
FEDERAL WAY
JOB NUMBER
17136
17136L,001.doc
SHEET
LOT LINE
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FND MONUMENT IN CASE EXHIBIT "A-1"
LEAD TACK
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® S.W. 330TH ST.
(MARCH 2O15)
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KCSP 278133R REC. NO. 8001170451
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LOT LINE TO BE REMOVED
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SCALE: For:
HORIZONTAL 1 "=60' VERTICAL N/A
18215 72NO AVENUE SOUTH
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�P(425)251-6222
425 251-8782 FAX Title:
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FEDERAL WAY 17136Loo1.doc
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€tI`W# ON I G ..r
CITY OF
Federal lay
RECEIVED
MAY 0 4 2015
CITY OF FEDERAL WAY
CDS
INFORMATION WORKSHEET
for
LOT LINE ELIMINATION
Project Name: CVS Retail Pharmacy Application Number:
Development Review Engineer:
Property Owner's Name (if Individual):
PUBLIC WORKS DEPARTMENT
33325 8`" Avenue South
Federal Way, WA 98003-6325
253-835-2700;Fax 253-835-2709
www.cJ1yoffedem1wgy.com
Property Owner's Name (if Proprietary): Convenience Retailers LLC
® Attach Signature Authority (This is an official document that has been submitted to the state showing who has authority to
sign legal documents on behalf of the company: i.e. Corporate Resolution, Company By -Laws, or State License showing
Corporate Officers.)
Mailing Address: 7180 Koll Center
Phone:
Suite 100 Pleasanton CA 94566
�C:y) (State) (7,M)
Fax Number:
EXISTING PROPERTY INFORMATION
Parcel Number(s): 132103-9098, 132103-9099
Address of Property: 33520 21 st Avenue S.W., Federal Way,WA 98023
Original Legal Description of Lot `A': See enclosed Lot Line Elimination Sheet 1 of 2
Attach additional sheets if necessary
Original Legal Description of Lot `B': See enclosed Lot Line Elimination Sheet 1 of 2
Attach additional sheets if necessary
Information Worksheet for Lot Line Elimination Page 1
PROPOSED PROPERTY INFORMATION
Legal Description of New Parcel: — See enclosed Lot Line Elimination Sheet 1 of 2
Attach additional sheets if necessary
ADDITIONAL REQUIRED ITEMS
OX Exhibit A: Map of Original Lots (two copies)
❑X Exhibit B: Map of New Parcel (two copies)
❑X Title Report (not more than one year old from the date of application) or a copy of the deed
conveying title to the current property owner(s).
Information Worksheet for Lot Line Elimination Page 2
CITY OF
Federal Way
RECEIVED MASTER LAND USE APPLICATION
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
MAY 04 2015 33325 8`s Avenue South
Federal Way, WA 98003-6325
CITY OF FEDERAL WAY 253-835 2607; Fax 253-835-2609
CDS ►aww.rityoffederilwa .com
APPLICATION NO(s) CJ,i1 t/ Date May 1, 2015
Project Name CVS Health
Property Address/Location 33520 21 st Avenue S.W., Federal Way, WA 98023
Parcel Number(s) 132103-9098, 132103-9099
Project Description Elimination of existing lot line that separates Lot A from Lot B, as described within the enclosed
worksheet. This request is part of the overall project to develop a 12,900 square foot CVS/pharmacy.
Type of Permit Required
Annexation
Binding Site Plan
Boundary Line Adjustment
Comp Plan/Rezone
Land Surface Modification
X Lot Line Elimination
Preapplication Conference
Process I (Director's Approval)
Process Il (Site Plan Review)
Process III (Project Approval)
Process TV (Bearing Examiner's Decision)
Process V (Quasi -Judicial Rezone)
_ Process VI
SEPA w/Project
SEPA Only
_ Shoreline: Variance/Conditional Use
Short Subdivision
Subdivision
Variance: Commercial/Residential
Required Information
Neighborhood Business Zoning Designation
Neighborhood Comprehensive Plan Designation
ommercia
$1,359,400 Value of Existing Improvements
$1,360,500 Value of Proposed Improvements
International Building Code (IBC):
M Occupancy Type
Construction Type
Applicant
Name: Marty Jones, TVC Construction Services, LLC.
Address: 5757 West Maple Road
City/State: West Bloomfield, MI
Zip: 48322
Phone: (206) 455-1756
Fax:
Email: mjones(@@ eir rn
Signature:
Agent (if di rent than Applicant) / Contact
Name: Nick Wecker, Barghausen Consulting Engineers (Contact)
Address: 18215 72nd Avenue South
City/State: Kent, WA
Zip: 98032
Phone: (425) 656-7469
Fax:
Email: nwecker@barghausen.ca
Signature: 1, f . � / j
C
Owner
Name: Convenience Retailers, LLC
Address: 7180 Koll Center Parkway, Suite 100
City/State: Pleasanton, CA
Zip: 94566
Phone: (925) 931-5776
Fax: (925) 406-0849
Email: hadib@pcandf.co
Signature: _
Bulletin #003 — January 1, 2011 Page 1 of 1 k:U3andoutslMaster Land Use Application
&[IAV
sG{ rr
he ENGIN
CIVIL ENGINEERING, LAND PLANNING, SURVEYING
RECEIVED
May 1, 2015
HAND DELIVERY MAY .0 4 2015
CITY OF FEDERAL WAY
City of Federal Way
Department of Community Development Services
33325 8th Avenue South
Federal Way, WA 98003
RE: Lot Line Adjustment
CVS Retail Pharmacy
33520 21st Avenue S.W., Federal Way Washington 98023
CVS No. 10659 / Our Job No. 17136
On behalf of TVC Construction Services, LLC, Barghausen Consulting Engineers, Inc. respectfully
requests that the Federal Way ❑epartment of Community ❑evelopment Services initiate review of the
enclosed Lot Line Adjustment application for the development of a CVS retail pharmacy at the location
referenced above.
Enclosed are the following documents for your review and processing:
1. One (1) signed Master Land Use Application
2. One (1) copy of the completed Information Worksheet for Lot Line Elimination
3. Two (2) copies of the Lot Line Elimination Legal Descriptions
4. Two (2) copies of the Lot Line Elimination Drawing
5. One (1) copy of the Title Report, dated March 18, 2015
6. One (1) check made payable to the City of Federal Way, in the amount of $192.50, for Lot
Line Adjustment review
It is our understanding that the enclosed items comprise a complete Lot Line Adjustment application, for
your review and processing. If you have any questions, please contact me at (425) 656-7469 or
nwecker@barghausen.com. Thank you.
;Sierej1y,Q
Nick A. Wecker
Assistant Planner
NAW/ADD/kb
17136c.004.doc
enc: As Noted
cc: Martin Jones, The Velmeir Companies
Jay S. Grubb, Barghausen Consulting Engineers, Inc.
Daniel B. Goalwin, Barghausen Consulting Engineers, Inc.
Chris Jensen, Barghausen Consulting Engineers, Inc.
Alexia D. Dorsch, Barghausen Consulting Engineers, Inc.
18215 72ND AVENUE SOUTH KENT, WA 98032 (425) 251-6222 (425) 251-8782 FAX
BRANCH OFFICES < TUMWATER, WA < LONG BEACH, CA • ROSEVILLE, CA • SAN DIEGO, CA
www.barghausen.com
WASHINGTON CVS PHARMACY, L.L.C.
SECRETARY'S CERTIFICATE
I, Melanie K. Luker, being the duly elected and acting Secretary of Washington
CVS Pharmacy, L.L.C., a Washington limited liability company (die "Company"), do
hereby certify that the individual listed below holds the title set forth opposite her name, and
that she has been duly authorized to execute and deliver any and all real estate documents on
behalf of the Company:
Name: Title:
Cheryl A. Green Assistant Secretary
IN WITNESS WHEREOF, the undersigned has executed this certificate on behalf
of the Company this 26th day of February, 2016.
Washington CVS Pharmacy, L.L.C.
By:
Melanie K. Luker
Secretary
Corporations: Registration Det�
Page 1 of 1
WASHINGTON CYS PHARMACY, LLC.
UBI Number
603215923
Category
LLC
Active/Inactive
Active
State Of Incorporation
WA
WA Fling Date
06/18/2012
Expiration Date
06/30/2016
Inactive Date
Duration
Perpetual
Registered Agent Information
Agent Name
CT CORPORATION SYSTEM
Address
505 UNION AVE SE STE120
City
OLYMPIA
WA
98501
Special Address Information
Address
City
State
Zip
G041'Ei l jgPfr50rLS
Title
Name
Address
Member
MOFFATT, THOMAS S
29 HOMESTEAD CIRCLE
KINGSTON , RI 02881
Member
DENALE, CAROL
75 POPLAR ST
WATERTOWN , MA 02472
Member
LUKER, MELANIE K
455 SUSAN DR
CRANSTON, RI 02920
Member
CIMBRON,LINDA
45BRIDGE ST
WARREN, RI 02885
Member
CLARK, JEFFREY
2 JOY LANE
HINGHAM , MA 02043
Member
DESROCKERS,JASON
359SANFORDRD
ALFRED , ME 04002
Member
FOULKES, HELENA
ONE CVS DRIVE
WOONSOCKET, RI 02895
http://www.sos.wa.gov/corps/search_detail.aspx?ubi=603215923
3/1/2016