HomeMy WebLinkAboutC17002806_Bill of Sale & Cost Data.pdfTYPE OF DOCUMENT:
GRANTOR(S):
GRANTEE:
NAME OF PROJECT:
ADDRESS OF PROJECT:
PROJECT FILE NUMBERS:
LEGAL DESCRIPTION:
PERSONAL PROPERTY DESCRIPTION:
Reference Number(s) of Documents assigned or released:
Additional reference #’s on page _____ of document
By By
Its Its
Public Hospital District # 1 of King County,
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 as described in
Exhibit B of this document.
a Municipal Corporation
City of Renton, a Municipal Corporation
ABBREVIATED LEGAL
DESCRIPTION:
THAT PORTION OF NEW LOT 2, 1ST AMENDMENT TO VALLEY MEDICAL
CENTER NORTH CAMPUS BINDING SITE PLAN, ACCORDING TO THE BINDING
SITE PLAN THEREOF, RECORDED UNDER RECORDING NUMBER
20171101001608, RECORDS OF KING COUNTY, WASHINGTON
ASSESSOR TAX PARCEL I.D. NUMBERS: 8857670100
Valley Medical Center - MOB
400 South 43rd Street
LUA16-000938, C17-002806, PLR-3964
See Attached Exhibit A of this Document
Return Address:
City Clerk’s Office
City of Renton
1055 South Grady Way
Renton, WA 98057
BILL OF SALE
Please make no mark in the margin space - Reserved for County Auditor's Use Only
Bill of Sale
See Attached Exhibit B of this Document
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.
IN WITNESS WHEREOF, said Grantor(s) has caused this instrument to be executed this ________ day of
_______________________ 20 _____ .
Page 1 of 4
INDIVIDUAL FORM OF ACKNOWLEDGEMENT
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 volumtary act for the uses and purposes
mentioned in this instrument.
Notary Public in and for the State of Washington
Notary (Print): ___________________________________________________
My appointment expires: __________________________________________
Dated: _________________________________________________________
REPRESENTATIVE FORM OF ACKNOWLEDGEMENT
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 acknowledge it as the ______________________________ and
__________________________ of _______________________ to be 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: _________________________________________________________
CORPORATE FORM OF ACKNOWLEDGEMENT
Notary Seal must be within box STATE OF WASHINGTON ) SS
COUNTY OF KING )
On this ____ day of ____________ , 20 _____ , before me personally appeared
_______________________________________________ to me known
to be _____________________________________ of the corporation that
executed the within instrument, and acknowledge the said instrument to be the free
and voluntary act and deed of said corporation, for the uses and purposes therin
mentioned, and each on oath stated that he/she was authorized to execute said
instrument and that the seal affixed is the corporate seal of said corporation.
Notary Public in and for the State of Washington
Notary (Print): ___________________________________________________
My appointment expires: __________________________________________
Dated: _________________________________________________________
BILL OF SALE
Project File Number: LUA16-000938, C17-002806, PLR-3964
Page 2 of 4
THAT PORTION OF NEW LOT 2, 1ST AMENDMENT TO VALLEY MEDICAL CENTER NORTH CAMPUS BINDING SITE PLAN,
ACCORDING TO THE BINDING SITE PLAN THEREOF, RECORDED UNDER RECORDING NUMBER 20171101001608,
RECORDS OF KING COUNTY, WASHINGTON
BILL OF SALE
EXHIBIT A
Legal Description
Project File Number: LUA16-000938, C17-002806, PLR-3964
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WTR -3964
WWP - 3964
SWP - 3964
TRO - N/A
TED - 3964
PROJECT NAME:
CONSTRUCTION PERMIT NO.
PROJECT FILE NUMBER:
WATER SYSTEM IMPROVEMENTS
QTY UNIT SIZE TYPE TOTAL COST
25 L.F.6"DI Water Main Pipe and Fittings 1,400.00$
2 L.F.12"DI Water Main Pipe and Fittings 160.00$
1 EA.4"Gate Valve Assembly 500.00$
4 EA.6"Gate Valve Assembly 2,800.00$
2 EA.12"Gate Valve Assembly 2,400.00$
2 EA.6"Fire Hydrant Assembly 8,000.00$
Subtotal 15,260.00$
Sales Tax 1,526.00$
Grand Total Water System Improvements 16,786.00$
Per the request of the City of Renton the following information is furnished concerning final costs for
improvements installed and turned over to the City for the referenced project.
ITEM
(City Staff Use Only)
EXHIBIT "B"
Contributary Assets
City Project Numbers:
Valley Medical Center - MOB
17-002806
16-000938
Return Address:
City Clerk’s Office
City of Renton
1055 South Grady Way
Renton, WA 98057
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