HomeMy WebLinkAboutWTR2703160Laucks Testing Laboratories, Inc.
940 S. Harney Seattle, WA 98108
WATER BACTERIOLOGICAL ANALYSIS
SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY
If instructions are not followed, sample will be rejected.
DATE COLLECTED I TIME COLLECTED COUNTY NAME
MONTH , DAY ,YEAR
❑ AM ❑ PM
TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE:
❑ PUBLIC
❑ INDIVIDUAL I.D. N0. CIRCALE GROUP
(serves only 1 residence)
NAME OF SYSTEM
SPECIFIC LOCATION WHERE SAMPLE COLLECTED TELEPHONE NO.
DAY( )
_ EVENING ( j
SAMPLE COLLECTED BY: (Name) SYSTEM OWNER/MGR.: (Name)
SOURCE TYPE ❑ GROUNDWATER UNDER SURFACE INFLUENCE
❑ SURFACE ❑ WELL or ❑ SPRING ❑ PURCHASED or ❑ COMBINATION
WELL FIELD INTERTIE or OTHER
SEND REPORT TO: (Print Full Name. Address and Zip Cade)
WASHINGTON
TYPE OF SAMPLE (check only one in this column)
❑ ROUTINE ❑Chlorinated (Residual Free)
DRINKING WATER
check treatment ❑Filtered
❑ Untreated or Other
❑ REPEAT SAMPLE IV
Previous coliform presence Lab # C/ 00/
Date / Z, 0k- 7
", YSys F^���,
❑ RAW SOURCE WATER Source # a m ❑ Total G^bliform
❑ NEW CONSTRUCTION or REPAIRS ❑ Fecal Coliform
❑ OTHER (Specify)
REMARKS:
(LAB USE ONLY) DRINKING WATER RESULTS
❑ UNSATISFACTORY, Coliforms present
❑ SATISFACTORY.
REPEAT ❑ E. Coli present ❑ E. Coll absent
Coliforms absent
SAMPLES Fecal present ❑ Fecal absent
REQUIRED ❑
OTHER LABORATORY RESULTS
TOTAL COLIFORM /100 ml E. COLI /100 ML
FECAL COLIFORM /100 ml PLATE COUNT _ /ml
ANOTHER SAMPLE REQUIRED
SAMPLE NOT TESTED BECAUSE: TEST UNSUITABLE BECAUSE:
❑ Sample too old ❑ Confluent growth
❑ Wrong container ❑ TNTC
❑ Incomplete form ❑ Turbid culture
❑ ❑ Excess debris
SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS
LAB NO. (7 DIGITS) DATE, TIME RECEIVED RECEIVED BY
DATE REPORTED LABORATORY:
REMARKS 1
DOH 305 002 (REV 4/92)
WATER SUPPLIER COPY
INTERPRETATION OF RESULTS
FOR DRINKING WATER
The analysis performed on this drinking water sample is an examina-
tion for the presence of coliform organisms in the water and indicates
the bacteriological quality of the sample. The presence of coliform
organisms is used by health organizations worldwide as an indicator
for the possible presence of other disease causing organisms.
REPORTING OF RESULTS:
Group A Public Water Systems must report the results of Drinking
Water Analysis to the State as specified in WAC 246-290-480.
SATISFACTORY RESULTS:
The absence of coliforms from any sample is satisfactory. Proper
system maintenance and bacteriological monitoring should be con-
tinued routinely to insure the safety of the water supply.
UNSATISFACTORY RESULTS:
Any coliform presence is unsatisfactory.
The presence of coliforms indicates the system is not properly
protected against contamination and may be unsafe for human con-
sumption. Unsatisfactory samples should be investigated IMMEDI-
ATELY and repeat samples submitted. Contact your local health
department or DOH Regional Office for assistance in determining
the source of contamination and corrective procedures.
When fecal coliforms or E.coli are reported present in a sample, the
IMMEDIATE ACTION REQUIRED by a Public System is:
1. Investigate to determine the cause and correct the situation.
Your local health department or DOH Regional Office can
assist you.
2. Submit repeat samples as specified in WAC 246-290-480.
3. Publicly notify the users of the public water systems as
specified in WAC 246-290-480.
4. Contact your local health department or DOH Regional
Office as specified in WAC 246-290-480.
TEST UNSUITA6LE:.Resample Immediately
"Confluent Growth:`inearl's bacteria have grown into a continuous
mass which makes counting impossible. "TNTC" means bacteria are
too numerous to count. "Excess Debris" means that particulates in
the water interfere with the interpretation of test results. "TGrbid
Culture" means an overgrowth of other bacteria can interfere With
coliform analysis. If any box indicating an unsuitable test is checked,
the presence of coliform bacteria could not be determined and a new
sample must be obtained for testing.
RESAMPLE:
Sample too old. (Sample to be tested must be received within 30 hours).
Not in proper container. (Bottle to be used for testing must be
purchased from a certified lab within 6 months.)
Insufficient volume. (Sample must be at least 100 ml)
If not tested, a new sample must be submitted for analysis.
FOR ADDITIONAL INFORMATION:
Contact your local health department OR the laboratory where this
sample was tested OR the Department of Health, Drinking Water
Program Regional Office.
AUG-'7-2004 TUE 02:18 PM KING CO
FAX NO. 2968431
P. 02/02
e
Laucks Testing Laboratories, Inc'
j' 940 S. Harney Seattle, WA 981 OB }
WATER BACTERIOLOGICAL ANALYSIS
SAMPLE C01_LECTION: RF.AO INSTRUCTIONS ON BACK OF GOLDENROD COPY
If InstrLlctions are not followod, sample will be rojocted.
DATGCt)LIr.Crco TIME GOLLECIL1) COUNTY NAME
MONTH DAY WAR
r [1� AM PM 'G ( ✓l
TYPO OF SYSTEM IF PURI..IC SYSTEM, COMPLETE:
Punt Ic
[) IND-7 CIRC,LE GROUP
IVIDUAL
(LD. Noy f S
(�crvhn onry 1 rn+.d.mrol
NAML OF SYS/rTm-COU�CTED T ELPHOwNE NO.SPCflCLY1nN M IEHE 5AMP
DAY (ZE_ U �r.)
1�U�%I EVENING
S�AM�NI—.P COLLECTED BY; (Narrity) SYSTEM OWNCFVMGR,; (Name)
0 t~ , w(q r - Sl-e C/__
Sr)URCV TYPC I I GROUND WA1 ER UNDER SUFI •ACC INFLUENCE
[_j SURFACI: ICJ WELL or 1 SPRING n PURCHASED or COMBINATION
WLLL FIELD IN 11971E or OTH!•R
�5j`'NIj) nr-.POR,r T0; (P ,nt Fu I Name, Addrussss and ZippCode) y�
�.51 f'•4 6'�..,.. .�1.—I <
`1JoS
'C OF SAMP(,t' (check only one in this column)
[� TSOUTING Chiorinaled (Ruidual: _._ _ Total _ Free)
DRINKINO WATF.n
011rCktrwilmont Fillerod
L] Untrualvd or Other
r� REPEAT SAMPLF
Pruwuun co1form presence.
Dato
u RAW SOURCE WATER Source Y Total Colrfomt
NCW CONSTRUCTION or REVAIIIS ❑ Fecal Coldorm
[� OTHER
(LAD USE ONI.) DRINKING WATER RESULTS
( UN .ATISFACTORY, Caldorms pre•,orrt SAIISFACTORY,
r� Colifo�ns ahsbnt
Rt:f'GAr LJ E. Colt present [ ] E. Cali obsont
SA1dl'LES flf'QUtRED Focai prwont Fecal absent
—� _U. OTHER LABORATORY RESULTS
TWAL COLIFORM _ n CO ml E. COLI _ A00 ML
I EC AL COU170RIVI —_ 1100_nit PLATE COUNT _ trnl
ANOTHER SAMPLE RCOUIRED
SAMf'L F NOT TESTED BECAUSE: TEST UNSUITABLE BECAUSE:
[� Sam plo too old [) Confluent growth
Wrong conlninw [] T NTC
r[a Intrimpletc town L] Turbid culture
�] ❑ Ex"ss dab.,;
SE4 6EVLAW SIOC OF GREEN COPY FOR EXPLANATION OF nESULTS
I A-i NO n 8i CATS, TiMr: RECCIVFn RECEIVED 9Y
LIA7E Ii Trl.o Y+ LAROTIC Ay
rtl Haler,;,
d
Laucks Testing Laboratories, Inc.
940 S. Harney Seattle, WA 98108
WATER BACTERIOLOGICAL ANALYSIS
SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY
If instructions are not followed, sample will be rejected.
DATE COLLECTED I TIME COLLECTED I COUNTY NAME
MONTH , DAY .YEAR
AM . ❑ PM -
TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE:
PUBLIC
❑ INDIVIDUAL I.D. N0. CIRCALE GB UP
(serves only 1 residence)
NAME OF SYSTEM
SPECIFIC LOCATION WHERE SAMPLE COLLECTED I TELEPHONE NO.
DAY ( 1
SAMPLE COLLECTED BY: (Name)
EVENING ( )
SYSTEM OWNER/MGR.: (Name)
SOURCE TYPE II GROUNDWATER UNDER SURFACE INFLUENCE
❑ SURFACE ❑ WELL or ❑ SPRING ❑ PURCHASED or ❑ COMBINATION
WELL FIELD INTERTIE or OTHER
SEND REPORT TO: (Print Full Name, Address and Zip Code)
TYPE OF SAMPLE (check only one in this column)
❑ ROUTINE ❑ Chlorinated (Residual: Total _Free)
DRINKING WATER
check treatment ❑ Filtered
❑ Untreated till
❑ REPEAT SAMPLE a ED
Previous coliform presence Lab #
Date /ael
-M2004
❑ RAW SOURCE WATER Source # � r� li l rF GR f�liform
❑ NEW CONSTRUCTION or REPAIRS
. IR , Woiiform
❑ OTHER (Specify)
REMARKS: w
dp
—
(LAB USE ONLY) DRINKING WATER RESULTS
❑ UNSATISFACTORY, Coliforms present
❑SATISFACTORY,
REPEAT ❑ E. Coli present ❑ E. Coll absent
,I Coliforms absent
SAMPLES
REQUIRED ❑ Fecal Fecal absent present ❑
OTHER LABORATORY RESULTS
TOTAL COLIFORM /100 ml E. COLI /100 MIL
FECAL COLIFORM _ /100 ml PLATE COUNT /ml
ANOTHER SAMPLE REQUIRED
SAMPLE NOT TESTED BECAUSE: TEST UNSUITABLE BECAUSE:
❑ Sample too old ❑ Confluent growth
❑ Wrong container ❑ TNTC
❑ Incomplete form ❑ Turbid culture
❑ ❑ Excess debris
SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS
LAB NO. (7 DIGITS) DATE, TIME RECEIVED RECEIVED BY
DATE REPORTED LABORATORY:
REMARKS
DOH 305 002 (REV. 4/92)
WATER SUPPLIER COPY
INTERPRETATION OF RESULTS
FOR DRINKING WATER
The analysis performed on this drinking water sample is an examina-
tion for the presence of coliform organisms in the water and indicates
the bacteriological quality of the sample. The presence of coliform
organisms is used by health organizations worldwide as an indicator
for the possible presence of other disease causing organisms.
REPORTING OF RESULTS:
Group A Public Water Systems must report the results of Drinking
Water Analysis to the State as specified in WAC 246-290-480.
SATISFACTORY RESULTS:
The absence of coliforms from any sample is satisfactory. Proper
system maintenance and bacteriological monitoring should be con-
tinued routinely to insure the safety of the water supply.
UNSATISFACTORY RESULTS:
Any coliform presence is unsatisfactory.
The presence of coliforms indicates the system is not properly
protected against contamination and may be unsafe for human con-
sumption. Unsatisfactory samples should be investigated IMMEDI-
ATELY and repeat samples submitted. Contact your local health
department or DOH Regional Office for assistance in determining
the source of contamination and corrective procedures.
When fecal coliforms or E.coli are reported present in a sample, the
IMMEDIATE ACTION REQUIRED by a Public System is:
1. Investigate, to determine the cause and correct the situation.
Yodr local health department or DOH Regional Office can
assist you.
2. Submit repeat samples as specified in WAC 246-290-480.
3. Publicly notify the users of the public water systems as
specified.in WAC 246-290-480.
4. Contact your local health department or DOH Regional
Office as specified in WAC 246-290-480.
TEST UNSUITABLE: Resample Immediately
"Confluent Growth" means bacteria have grown into a continuous
mass which makes counting impossible. "TNTC" means bacteria are
too numerous to count. "Excess Debris" means that particulates in
the water interfere with the interpretation of test results. "Turbid
Culture" means an overgrowth of other bacteria can interfere with
coliform analysis. If any box indicating an unsuitable test is checked,
the presence of coliform bacteria could not be determined and a new
sample must be obtained for testing.
RESAMPLE:
Sample too old. (Sample to be tested must be received within 30 hours).
Not in proper container. (Bottle to be used for testing must be
purchased from a certified lab within 6 months.)
Insufficient volume. (Sample must be at least 100 ml)
If not tested, a new sample must be submitted for analysis.
FOR ADDITIONAL INFORMATION:
Contact your local health department OR the laboratory where this
sample was tested OR the Department of Health, Drinking Water
Program Regional Office.
FAX NO, HU84J1 r. Ue
Laucks Testing Laboratories, Inc.
940 S. Harney Seattle, WA 98108
WATER BACTERIOLOGICAL ANALYSIS
SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY
If Instructions are not followed, sample will De rejected.
DATE COLLLCIED TIMECOLLECIED COUNTYNAML
MONTH DAY YEAS /0 : -70
O ® AM PM % V l (
TYPE OF SY;;1 EM Ir• MBL1C SYSFFM, COMPLATE:
PUBLIC Cin�KJ.�. CROLIF'
U INDIVIDLIAL LD. No. 7 U B
I"rvh only t re *wftl �•J
,n
IRC L ON WHERE SYPLE COLLECTED TELEPHONE NO
tlrc�ia� 1 S7 / I Zy j_.__...._.
SAMPLE COLLECTED BY: (N:,mu) SYSTFM OWNfR/MGFi.: Name)
SOURCETYPE rjGROUNDWATER UNDERSCCINFLUrNCE
SURFACE Rj WFL.t. or ❑ SPRING ❑ PURCHASED or COMBINATION
WELL FIELO INTER'CE or OT(IC;R
SEND EPORT Tj,� ( int Full Q�lvno, Add s d 7rp C la) —�
tea' nl I < � AA TOT_��
Ra fS-
TYPE OF SAMPLE (check only one to this column)
ROUTINE Chlorlrutad (nonxdualr Total ,, _ Free)
DRINKING WATER
chock trea(mont F(Ilerod
UnlrwtCd or Oilier_
l J REPEAT SAMPLE
Provlour cnlllorm presence 1.9b
Dale
[� FLAW SOUIICC WATFn source #Fs -I U 1-17
W
® NEW CONSTRUCTION or RCPAIRS
OTHER (Specify)_._- —
REMARKS: /o . 0,
-# 1-70 -? %
Total Coliforrn
U Feo91 Coliforni
(LAB USE ONLY) DRINKING WATER RESULTS
ff
UNSATISFACTORY, Coliforms prazwnt SATIS�nCTORY
Coliforms absent
REPEAT ❑ E. Coll presunt U E. Coli obfiant
SAMPLES RFOUIRF:D Fecal prosont Fecal ut'6unt
OTHER LABORATORY RESULTS
TOTAL COLIFORM /100 ml E. COLI ,_ /100 MI_
FECAL. C01_IFORM _ 1100 ml PLATE COUNT Iml
ANOTHER SAMPLE REOUIRED
SAMPLE NOT TESTED BECAUSE: TEST UNSUITABLE LICCAUSE:
Ssmple too old COMIL.ant Growth
Wrona container [_� TNTC
[] Incomplete form Ll lurbld culture
[� Excess dabrie
SEE REVERSE SIDE OF liFlttN I:UPT rVri th'L-A— n — --- ••
LAB NO Q 013rr$1 DATE, TIME RECOVED HCCF.IVED 9Y
r,1__.0_�
DATE REPORWD wHORA'i RY.
Q� u
ReturnAddress:
City Clerk's Office
City of Renton
1055 South Grady Way
Renton, WA 98055
20041025002298
CITY OF RENTON Bs 20.00
KING COUNTY. UA
BILL OF SALE �, " 3 : , -
Property Tax Parcel Number:
Project File #:
L�/f - a¢-//�
tree In�e10
�ec" on:
2 %
Address:
Reference Number(s) of Documents assigned or released: Additional reference numbers are on page
Grantor(s):
1. L brq�Ia �e��U res L. L G
Grantee(s):
a /
1. City of Renton, a Municipal Corporation
2.
The Grantor, as named above, for, and in consideration of mutual benefits, hereby grants, bargains, sells and delivers to
the Grantee, as named above, the following described personal property:
WATER SYSTEM: Length
Size Type
Z,11— L.F. of
/ . Water Main
/(o L.F. of
j�. /, Water Main
L.F. of
Water Main
2 each of
Gate Valves
each of
Gate Valves
each of
Fire Hydrant Assemblies
SANITARY SEWER SYSTEM: Length
Size Type
169 L.F. of
6 "-,yG Sewer Main
.5 � L.F. of
Q y G Sewer Main
L.F. of
Sewer Main
each of
t7l'd Diameter Manholes
each of
Diameter Manholes
each of
Diameter Manholes
STORM DRAINAGE SYSTEM: Length
Size Type
/q 2
L.F. of
Storm Line
L.F. of
Storm Line
L.F. of
Storm Line
each of
_
Storm Inlet/Outlet
each of
_L
Storm Catch Basin
each of
Manhole
STREET IMPROVEMENTS: (Including Curb, Gutter, Sidewalk, Asphalt Pavement)
Curb, Gutter, Sidewalk e � o L.F.
Asphalt Pavement: / —7 % 3
SY or
L.F. of
Width
STREET LIGHTING:
# of Poles 2
By this conveyance, Grantor will warrant and defend the sale hereby made unto the Grantee against all and every person
or persons, whomsoever, lawfully claiming or to claim the same. This conveyance shall bind the heirs, executors,
administrators and assigns forever.
I I:\FILE. SYS\FRM\84] INDOU"IIBILLSALE.DOC\MAB
Page 1
..
UUU I / bh
0
hereunto set my hand and seal the day and year as written below.
INDMDUAL FORM OFACKNOWLEDCMENT
Notary Seal must be within box STATE OF WASHINGTON ) SS
COUNTY OF KING )
I certify that I know or have satisfactory evidence that
signed this instrument and
acknowledged it to be his/her/their free and voluntary act for the uses and purposes
mentioned in the instrument
Notary Public in and for the State of Washington
Notary (Print)
My appointment expires:
Dated:
Notary Seal must be within box STATE OF WASHINGTON ) SS
COUNTY OF KING )
I certify that I know or have satisfactory evidence that
signed this instrument, on oath
stated that he/she/they was/were authorized to execute the instrument and
acknowledged it as the and
of to be the free and voluntary act of such
party/parties for the uses and purposes mentioned in the instrument.
Notary Public in and for the State of Washington
Notary (Print)
My appointment expires:
Dated:
Notary Seal must be within box STATE OF WASHINGTON ) SS
COUNTY OF KING ) 2�
On this )0 day of f9— , before me personally appeared
_r5RAd C.EY K- q'46F(C-75 to me known to
beof the corporation that
executed the within instrument, and acknowledge the said instrument to be the free
LCMLES F. KOKKO and voluntary act and deed of said corporation, for the uses and purposes therein
TARYPUBLIC mentioned, and each on oath stated that he/she was authorized to execute said
OF tNASHINGTON instrument and that the seal affixed is the corporate seal of said corporation.
MISSION EXPIRESARCH 19, 2006
.,� Notary Public in an for t�}e State f W s on
Notary (Print) 1 ► to S 9
My appointme t ex fires: q o
Dated: (D /(0 �' e
Page
PROJECT CLOSING
FINAL COST DATA AND INVENTORY
#4 Final Cost Data
and Inventory
SUBJECT: [-4[ 04' /41� P CITY PROJECT NUMBERS: 31 Cl
D`;Ap- e% Z S
Name of project O-
TED-
TO: City of Renton FROM: 12>16d �E e-1c 2--
Plan Review Section
Planning/Building/Public Works
200 Mill Avenue South
Renton, WA 98055 DATE: O C.f•. /ZA ZOD
Per the request of the City of Renton, the following information is furnished concerning final costs for improvements
installed for the above referenced project.
WATER SYSTEM CONSTRUCTION COSTS:
Length Size Type
Z11.� L.F. of
/14�p_ L.F. of
L.F. of
L.F. of "
EACII of "
�— EACH of "
EACH of "
/ EACH of "
(Cost of Fire Hydrants must be listed separately)
(Include Engineering and Sales Tax if applicable
WATERMAIN
WATERMAIN
WATERMAIN
WATERMAIN
GATE VALVES
GATE VALVES
GATE VALVES
FIRE HYDRANT ASSEMBLIES $ �D/ I)o 0
$
$
TOTAL COST FOR WATER SYSTEM $ 6ZW'C;0
SANITARY SEWER SYSTEM: STORM DRAINAGE SYSTEM:
Length
Size
Type
io9 L.F. of
N'
SEWER MAIN
L.F. of
SEWER MAIN
L.F. of
SEWER MAIN
/ EA of
DIAMETER MANHOLES
EA of
DIAMETER MANHOLES
(Including (Including Engineering
and Sales Tax
�/— ,ec) a
if applicable)
S 0
TOTAL COST FOR SANITARY SEWER
SYSTEM Om
Length Size Type
Z& L.F. of 1� " (���
STORM LINE
L.F. of
STORM LINE
L.F. of
STORM LINE
EA of /
STORM INLEI'/OtITLET
EA of
STORM CATCHBASIN
EA of
STORM CATC14BASIN
(including Engineering and Sales Tax
S� e7
if applicable)
S'Z 5 —Z
TOTAL COST FOR STORM DRAINAGE SYSTEMa—
STREET IMPROVEMENTS: (Including Curb, Gutter, Sidewalk, Asphalt Pavement and Street Lighting)
SIGNALIZATION: (Including Eng. Design Costs, City Permit Fees, WA St Sales Tax)
STREETLIGHTING: (Including Eng. Design Costs, City Permit Fees, WA St Sales Tax)
Print signatory name ay phone #
(SIGNATURE)
forms/COSTDAT2.DOCfbh (Sig story must be authorized agent
or owner of subject development)
W- 3 ),Z 5
Jill
1215000027
ILON BS
20.00
BILLOFSALE
Project �4am�,`. Property Tax Parcel Number.
.Nichqison.Shoo Plat 334510-0003-03
Project File #: LUA-02-1 11 Stet IntersectiorL, N-.E. 28 •.Street Address: 2300 N.E. 2e Street
Reference Number(s) of Documents assigned or released- Additional riferen6e n3kimbo6;'s are on page
Grantor(s): .`Grantee(s).-.J
�'U
1. Brad Nlehqlson ..,-.,:.City of Reto a M Coy'hiripal pqration
The Grantu", asrkamed:above, for, and inconsideration of m'i""benerits,..h"ereb.y:•gr!�nt*b:.r'ain:s sells and. -delivers to the
Grantee as named above, the following described personal property''
WATF4R SYSTEM: Length Size
135' L.F. of 8 inch Diictikq'-on Water..Main
6' L.F. of 6 inch Ductile iron Vater Main
each of 8 inch tapping Gate Valves
1 each of 8 inch standard Gate Valves
j
I' each of IOWAF-5110 Corey type Fire Hydrant Assembly
SANITARY SEWEiZ SYSTEM: Size Type
184'." L.F.0 inch PVC Sewer Main
ca6h of..-.*' 48 Concrete Diameter Manholes
STORM DRAINAGE SYSTEM: :'...Leng Size lype
none I.F. of • no: no Storm Main
(1) each of 5- foot diameter: type. 2 Storm Catch Basin
:
STREET EWPROVMENTS: (Including Curb, Gutter, Sidewalk; ASpwt P "In"t)
Curb, Gutter, Sidewalk 81 L.F.
.;treei
Asphalt Pavement: 81 L. F. of 20' Width'; iontap,ir4pro�e eat
In'.
STREET LIGHTING:
# of Poles No street lights
Bvthis c nveyance, Grantor will wan -ant and defend the vile hereby made unto the Grantee against all and every p6rsoribr persons.
whomsoever, lawfully claiming or to claim the same. This convel-ance shall bind the heirs, executors, adrnir�htrators and -assigns; fo(ever.
C:\Docurnents and Settings\Owner\My DocnmentsMort Plat ApplicationTED AND EASE and FINAL APPLICAMOf�l\BILLSALE
final.DOM Page I
INDIVIDUAL FORbIOFACKA'O1VI,ED(;bfEN'f
Notary Seal must be within box.-
STATE'OP WASHINGTON ) SS
COUNTY OF KING )
�,.•'' ``'�e . %.
; T certify; that I know or have satisfactory evidence that
• `as F ` y
signed this instnunent and
acicnovul ged it io. b i erltheir free and voluntary act for the uses and purposes
men fidhed in the instrument
2 g'°• .�
:Notary Public ir' and for the State of Washington
rF c.{.. •��,�,
Notary (Print)` iV''Al
My appciinttrient:expires: yr. dR= "D
Dated:: h- i;,, -. r^
Notary Seal must be within box STATE OF WASEIINGTON ) SS
COUNTY OF KING
I certify that I know o%have satisfactoo evidence dial
ned this:instrumeot, on oath
stated that he/she/they was/were authprized to execute the in�tntu ent and
acknowledged it as the and
of to be the free and'voluntary act of:snch
party/parties for the uses and purposes mentioged in the instru*nt.
Notary Public in and for the State of Washington:.
Notary (Print)
My appointment expires:
• Dated: .
r' f.;UJC'(.t101rr8 PUXM UP A(.AtVUWJ, U(GML1;V7T
Notary Seal must be within box; STATE OF WASHII�IGTON ) SS
COUNTY OF DING ):..
On this . day of.:: :,r 20____, before me personally appeared
to me known to
be:. of the corporation that
execuitd the mthin instnunent, andacknowtedge the said instrument to be the free
and voluntar�,act and`depd of said.corporalion, for'the.uses and purposes therein
mentioned, and each on oath stated thathe/she was authorized to execute said
inst -n ment and ihattlie seal, affixed is. -hie cgiporatc_Seal of said corporation.
Notary Public in and for the'State' of Washington'
Notary (Print)
My appointment expires:
Dated:
C:\Documents and Settings\OwnerWy Documents\Short Plat Application\DED AND EASE and FINAL APPLICATIOI 8IL SALI?'
fmaLDOC\b :Page 2:•