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HomeMy WebLinkAboutA_Application_Form_Meadow_Ave_210226_v2PROJECT INFORMATION (CONTINUED) SQUARE FOOTAGE OF PROPOSED RESIDENTIAL IS THE SITE LOCATED IN ANY TYPE OF ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE SQUARE FOOTAGE (if applicable): BUILDINGs (if applicable) TBD sQUARE FOOTAGE OF EXISTING RESIDENTIAL BUILDINGS TO REMAIN (if applicable): 0 AQUIFER PROTECTION AREA ONE SQUARE FOOTAGE OF PROPOSED NON-RESIDENTIAL AQUIFER PROTECTION AREA TWO BUILDINGS (if applicable) N/A OFLOOD HAZARD AREA Sq. ft. SQUARE FOOTAGE OF EXISTING NON-RESIDENTIAL BUILDINGS TO REMAIN (if applicable): 0 GEOLOGIC HAZARD sq. f NET FLOOR AREA ON NON-RESIDENTIAL BUILDINGS (if applicable) N/A HABITAT CONSERVATION sq. . SHORELINE STREAMS & LAKES sq. i NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE NEW PROJECT (if applicable) N/A WETLANDS sq.ft LEGAL DESCRIPTION OF PROPERTY (Attach legal description on separate sheet with the following information SITUATE IN THE NW OF RENTON, KING cOUNTY, WASHINGTON QUARTER OF SECTION 32TOWNSHIP 24N, RANGE _5 w.M. IN THE CITY AFFIDAVIT OF OWNERSHIP I.(Print Name/s) The Cuong Nguyen & Thi Yen Va declare under penalty of perjury under the laws of the State of Washington that am (please check one) the current owner of the property involved in this application or the authorized representative to act for a corporation (please attach proof of authorization) and that the foregoing statements and answers herein contained and the information herewith are in all respects true and correct to the best of my knowledge and belief. 02/272021 Signature of Owner/Representative Date Signature of Owner/Representative Date STATE OF WASHINGTON SS COUNTY OF KING I certify that know or have satisfactory evidence that_Huy NGU YEN acknowledge it to be his/her/their free and voluntary act for the uses and purpose mentioned in the instrument. signed this instrument and 27/2o2 Dated Notary Ppblic in andor the State of Washington J SING EXPIR oTAR www H SOHA akHAAT UGMSOtA RAJ S Notary (Print): SSON Au 9 2023 95560 My appointment expires: 8. ATE OF SHINGTO N www X DURABLE POWER OF ATTORNEY (Effective Notwithstanding Disability or Incapacity) ,Thi Yen Van Pham, ("Principal"), domiciled and residing in the State of Washington, hereby revoke any other powers of atorney which Principal may have previously executed, and in their place execute this Durable Power of Attorney, as follows: 1. Designation of Attorneys-In-Fact. Huy T. Nguyen is hereby designated as attorney-in-fact for Principal. 2. Effectiveness and Duration. This power of attorney shall become effective upon execution and shall remain in effect until revoked or terminated under paragraph 4 or 5 below, notwithstanding any uncertainty as to whether Principal is dead or alive. This power of attormey shall not be affected by disability of Principal.Disability or incapacity shall include inability on the part of Principal to manage Principal's property and affairs effectively for reasons such as mental iliness, mental deficiency, physical illness or disability, advanced age, chronic use of drugs, chronic intoxication confinement,detention by a foreign power or terrorists,or disappearance. Revocation. This power of attorney may be revoked, suspended or terminated by Principal at any time Principal is not disabled or incapacitated, as defined in 2, above, if Principal sends written notice to the designated and acting attorney-in-fact (if already acting as such) or to the first designated attorney-in-fact (if this power of attorney has not yet been made use of by that time). In addition, if this power of attorney has been recorded, the written instrument of revocation shall be recorded in the office of the Recorder/Auditor of any county in which the power of attorney is 3. recorded. 5. Termination. A. By Guardian of Estate. The appointment of a guardian of the estate of Principal vests in the guardian, with court approval, the power to revoke, suspend or terminate this power of attorney. The appointment of a guardian of the person only does not empower the guardian to revoke, suspend or terminate this power of attorney. B. By Death of Principal.The death of Principal shall be deemed to revoke this power of attorney upon actual knowledge or actual notice being received by the attorney-in-fact. 6. Powers. The attorney-in-fact, as a fiduciary, shall have all powers of an absolute owner over the assets and liabilities of Principal, whether located withinor without the State of Washington, including, without limitation, the power and authority to: A. Make deposits to, and payments from, any account in a financial institution in the name of Principal, and enter any safe deposit box to which Principal has a right of access and deposit or remove property therefrom. B. Sell, exchange, or otherwise transfer title to Principal's stocks, bonds, or other securities. C. Sell, convey, exchange or otherwise transfer or encumber any real or personal property of Principal. D. Disclaim, in whole or in part, any interest in property, whether outright, in trust, or otherwise, so long as in the sole discretion of the attorney-in-fact such disclaimer would not be detrimental to the best interests of Principal, and would be in the best interests of those interested in the estate of Principal and of those who take as a result of any such disclaimer. E. Prepare, or arrange for the preparation of, all federal and state income tax and gift tax returns on behalf of Principal,execute and submit such returns and pay all such taxes as may be due. Represent Principal with respect to audits, appeals, and lawsuits related to any income or gift tax return filed on behalf of Principal, and pay any assessments for interest or penalties levied against Principal in connection with such F. tax returns. G. Make transfers of Principal's property, both real and personal, to any trust created by Principal of which Principal is the primary beneficiary during Principal's life. H. Make transfers of Principal's property, including but not limited to transfers to Principal's spouse and gifts to Principal's children, for the purpose of qualifying Principal for governmental medical assistance to the full extent provided by law should there be a need for medical care or for the purpose of preserving for Principal's spouse the maximum amount of property allowed under applicable law if an application has been made for governmental medical assistance for Principal. Any transfers made pursuant to this paragraph shall be deemed not to be a breach of fiduciary duty by the attorney-in-fact. Make gifts, whether outright or in trust, to the relatives of Principal and the spouses of any such relatives, in accordance with any pattern of making gifts to such persons which Principal has established or planned to establish or in such amounts as the attorney-in-fact shall determine appropriate so long as such gifts would be in the best interests of Principal and those interested in the estate of Principal, such determination to be made in the sole discretion of the attorney-in-fact. J. Make, amend, alter or revoke any community property agreement, agreement as to status of property, or other document of similar import entered into by Principal and Principal's spouse, and make, amend, alter or revoke any of Principal's life insurance beneficiary designations and retirement plan beneficiary designations so long as in the sole discretion of the attorney-in-fact such action would be in the best interests of Principal and those interested in Principal's estate. K. Provide informed consent to (1) medical and surgical care and non-treatment for Principal, (2) the withholding or withdrawal of life-sustaining treatment for Principal, and (3) the admission of Principal to a medical, nursing, residential, or similar facility; enter into agreements for Principal's care; pay from Principal's assets reasonable expenses incurred with respect to the exercise of the authority granted herein to make health care decisions for Principal or with respect to the enforcement of any Directive to Physicians executed by Principal; and override the provisions of any Directive of Physicians executed by Principal. In addition to the other powers granted by this Power of Attorney,I hereby grant to my agent the power and authority as Personal Representative for all purposes of the Health Insurance Portability and Accountability Act (HIPPA), 42 USC 1320(d), and its regulations, including but not limited to authority to review, copy and consider confidential health information and medical records. 7. Intent to Obviate Need for Guardianship. It is Principal's intent that the power given to the attorney-in-fact designated herein be interpreted to be so broad as to obviate the need for the appointment of a guardian for the person or estate of Principal. If the appointment of a guardian or limited guardian of the person or estate of Principal s sought, however, Principal nominates the then acting attorney-in-fact designated above, if any, as Principal's guardian or limited guardian, or if no one is then acting as attorney-in-fact and successor attorneys-in-fact as guardian or limited guardian, in the same order of priority. 8. Accounting. The attorney-in-fact shall be required to account to any subsequently appointed guardian or personal representative for Principal 9. Reliance. All persons dealing with the attorney-in-fact shall be entitled to rely upon this power of attorney so long as they have no actual knowledge nor actual notice of any revocation, suspension or termination of this power of attorney by death or otherwise.Any action taken pursuant to this power of attorney, unless otherwise invalid or unenforceable, shall be binding on Principal and on Principal's successors in interest. 10. Indemnity.The estate of Principal shall hold harmless and indemnify the attorney-in-fact from all liability for acts done in good faith and not in fraud of Principal. Reliance on Photocopy Hereof. Third paties shall be entitled to rely upon a photocopy of the signed original hereof, as opposed to a cetified copy of the 11. same. 12. Applicable Law. The laws of the State of Washington shall govern this power of attorney. DATED this_lday of 0 , 2019 Thi Yen Van Pham Domiciled and Residing at: 500 SE 155IH P STATE OF Aahugla ) SS. COUNTY OF th This is to certify that on this day of September 2019, before the undersigned Notary Public, personally appeared Thi Yen Van Pham to me known to be the person described in and who executed the Durable Power of Attorney, and acknowledged to me that he signed and sealed the same instrument as her free and voluntary act and deed, for the purposes therein mentioned. SUBSCRIBED AND SwORN TO before me this /6_day of September 2019. titi. TI VUON MISs A wwwwp Notary Public in and for the State of Wazus/r Residing atkelo uA 1-09- OF 20 VASHIN TON li DURABLE POWER OF ATTORNEY (Effective Notwithstanding Disability or Incapacity) I, The Cuong Nguyen, ("Principal"), domiciled and residing in the State of Washington, hereby revoke any other powers of attorney which Principal may have previously executed, and in their place execute this Durable Power of Attorney, as follows: Designation of Attorneys-In-Fact. Huy T. Nguyen is hereby designated as attorney-in-fact for Principal. 2. Effectiveness and Duration. This power of attorney shall become effective upon execution and shall remain in effect until revoked or terminated under paragraph 4 or 5 below, notwithstanding any uncertainty as to whether Principal is dead or alive. This power of attorney shall not be affected by disability of Principal. Disability or incapacity shall include inability on the part of Principal to manage Principal's property and affairs effectively for reasons such as mental illness, mental deficiency, physical illness or disability, advanced age, chronic use of drugs, chronic intoxication, confinement, detention by a foreign power or terrorists, or disappearance. 3. Revocation. This power of attorney may be revoked,suspended or terminated by Principal at any time Principal is not disabled or incapacitated, as defined in 2, above, if Principal sends written notice to the designated and acting attorney-in-fact (if already acting as such) or to the first designated attorney-in-fact (if this power attorney has not yet been made use of by that time). In addition, if this power of attorney has been recorded, the written instrument of revocation shall be recorded in the office of the Recorder/Auditor of any county in which the power of attorney is recorded 5. Termination. A. By Guardian of Estate. The appointment of a guardian of the estate of Principal vests in the guardian, with court approval, the power to revoke, suspend or terminate this power of attorney. The appointment of a guardian of the person only does not empower the guardian to revoke, suspend or terminate this power of attorney. B. By Death of Principal. The death of Principal shall be deemed to revoke this power of attorney upon actual knowledge or actual notice being received by the attorney-in-fact. 6 Powers. The attorney-in-fact, as a fiduciary, shall have all powers of an absolute owner over the assets and liabilities of Principal, whether located within or without the State of Washington, including, without limitation, the power and authority to: A Make deposits to, and payments from, any account in a financial institution in the name of Principal, and enter any safe deposit box to which Principal has a right of access and deposit or remove property therefrom. B. Sell, exchange, or otherwise transfer title to Principal's stocks, bonds, or other securities. C. Sell, convey, exchange or otherwise transfer or encumber any real or personal property of Principal. D. Disclaim, in whole or in part, any interest in property, whether outright, in trust, or otherwise, so long as in the sole discretion of the attorney-in-fact such disclaimer would not be detrimental to the best interests of Principal, and would be in the best interests of those interested in the estate of Principal and of those who take as a resut of any such disclaimer. E. Prepare, or arrange for the preparation of, all federal and state income tax and gift tax returns on behaf of Principal, execute and submit such returns, and pay all such taxes as may be due. F. Represent Principal with respect to audits, appeals, and lawsuits related to any income or gift tax return filed on behalf of Principal, and pay any assessments for interest or penalties levied against Principal in connection wit tax returns. G. Make transfers of Principal's property, both real and personal, to any trust created by Principal of which Principal is the primary beneficiary during Principal's life H. Make transfers of Principal>'s property, including but not limited to transfers to Principal's spouse and gifts to Principal's children, for the purpose of qualifying Principal for governmental medical assistance to the full extent provided by law should there be a need for medical care or for the purpose of preserving for Principal's spouse the maximum amount of property allowed under applicable law if an application has been made for governmental medical assistance for Principal. Any transfers made pursuant to this paragraph shall be deemed not to be a breach of fiduciary duty by the attorney-in-fact. Make gifts, whether outright or in trust, to the relatives of Principal and the spouses of any such relatives, in accordance with any pattern of making gifts to such persons which Principal has established or planned to establish or in such amounts as the attorney-in-fact shall determine appropriate so long as such gifts would be in the best interests of Principal and those interested in the estate of Principal, such determination to be made in the sole discretion of the attorney-in-fact. J. Make, amend, alter or revoke any community propety agreement, agreement as to status of property, or other document of similar import entered into by Principal and Principal's spouse, and make, amend, alter or revoke any of Principal's life insurance beneficiary designations and retirement plan beneficiary designations so long as in the sole discretion of the attorney-in-fact such action would be in the best interests of Principal and those interested in Principal's estate. K. Provide informed consent to (1) medical and surgical care and non-treatment for Principal, (2) the withholding or withdrawal of life-sustaining treatment for Principal, and (3) the admission of Principal to a medical, nursing, residential, or similar facility; enter into agreements for Principal's care; pay from Principal's assets reasonable expenses incurred with respect to the exercise of the authority granted herein to make health care decisions for Principal or with respect to the enforcement of any Directive to Physicia Directive of Physicians executed by Principal. s executed by Principal; and override the provisions of any In addition to the other powers granted by this Power of Attorney, I hereby grant to my agent the power and authority as Personal Representative for all purposes of the Health Insurance Portability and Accountability Act (HIPPA), 42 USC 1320(d), and its regulations, including but not limited to authority to review, copy and consider confidential health information and medical records. 7. Intent to Obviate Need for Guardianship. It is Principal's intent that the power given to the attorney-in-fact designated herein be interpreted to be so broad as to obviate the need for the appointment of a guardian for the person or estate of Principal. If the appointment ofa guardian or limited guardian of the person or estate of Principal is sought, however, Principal nominates the then acting attorney-in-fact designated above, if any, as Principal's guardian or limited guardian, or if no one is then acting as attorney-in-fact and successor attorneys-in-fact as guardian or limited guardian, in the same order of priority. 8. Accounting. The attorney-in-fact shall be required to account to any subsequently appointed guardian or personal representative for Principal. 9. Reliance. All persons dealing with the attorney-in-fact shall be entitled to rely upon this power of attorney so long as they have no actual knowledge nor actual notice of any revocation, suspension or termination of this power of attorney by death or otherwise. Any action taken pursuant to this power of attorney, unless otherwise invalid or unenforceable, shall be binding on Principal and on Principal's successors in interest. Indemnity. The estate of Principal shall hold harmless and indemniry the attorney-in-fact from all liability for acts done in good faith and not in fraud of Principal. 10. 11. Reliance on Photocopy Hereof. Third parties shall be entitled to rely upon a photocopy of the signed original hereof, as opposed to a certified copy of the same. 12. Applicable Law. The laws of the State of Washington shall govern this power of attorney. DATED this day of_O 2019. The Cuong Nguyen L5400 SELIHLPL #44 Renlm WA 436TN Domiciled and Residing at: /A 4goSi STATE OFathugh SS. cOUNTY OFK This is to certify that on this l day of September 2019, before the undersigned Notary Public, personally appeared The Cuong Nguyen to me known to be the person described in and who executed the Durable Power of Attorney, and acknowledged to me that he signed and sealed the same instrument as her free and voluntary act and deed, for the purposes therein mentioned. SUBSCRIBED AND sWORN TO before me this_day of September 2019. TIE. vUNG MISSiO NO Notary Public in and for the State of_WMusla Residing at WA LIC 11-09 9-20. ASHIN VGTON P AR, Meadow Ave Short Plat Legal Description – Master Application 01-29-2021 TAX PARCEL 334270-0570 THE WEST 236 FEET OF TRACT 113, WEST 236 FEET OF THE SOUTH HALF OF TRACT 112, HILLMANS LAKE WASHINGTON GARDEN OF EDEN ADDITION TO SEATTLE NO. 2, ACCORDING TO THE PLAT RECORDED IN VOLUME 11 OF PLATS, PAGE 64, RECORDS OF KING COUNTY, WASHINGTON; EXCEPT THAT PORTION CONVEYED TO THE STATE OF WASHINGTON BY DEED RECORDED UNDER AUDITOR’S FILE NO. 4648613 FOR SECONDARY STATE HIGHWAY NO. 2-A; TOGETHER WITH THAT PORTION VACATED BY THE CITY OF RENTON ORDINANCE NO. 5878. AS RECORDED UNDER RECORDING NO. 20180305000483. SITUATE IN THE CITY OF RENTON, COUNTY OF KING, STATE OF WASHINGTON.