HomeMy WebLinkAboutCash Surety Deposit Deferral Assurance Notarized.pdfDEPARTMENT OF COMMUNITY
AND ECONOMIC DEVEOPMENT
Q
CASH SURETY DEPOSIT -
DEFERRAL ASSURANCE
APPLICANT Name and Address
Name: 90,VA E124ii FA,0PZT?217E_S 2 "
Address:3074 90S21-SE
Phone#:(,/,sy) &&g^S701
Project No. / Permit No.
PR16-000504 / DEF21003104
Project Name
Bethany Corner Short Plat
Cash Surety Deposit
$ 90,000.00
Site Location
16433 111th Ave SE
The City of Renton (the "CITY"), hereby acknowledges receipt from the above -named APPLICANT, who
has paid the cash surety deposit amount noted above.
The APPLICANT hereby authorizes that the sum referenced above be kept on deposit with the City of
Renton Finance Department for the purpose of guaranteeing that the above -referenced project will be
completed in accordance with approved plans and conditions and applicable City standards no later than
3 za Z These improvements are described on the above referenced
permit(s).
The City of Renton (the "CITY"), hereby acknowledges receipt from the above -named APPLICANT, who
has paid the cash surety deposit amount noted above.
The APPLICANT hereby authorizes that the sum referenced above be kept on deposit with the City of
Renton Finance Department for the purposes of guaranteeing that the above -referenced project will be
maintained in accordance with the _ ("AGREEMENT") for the project.
THE CONDITIONS OF OBLIGATION is that:
1. Until written release of this obligation by the CITY, this cash financial guarantee may not be terminated
or cancelled by the APPLICANT for anv reason.
2. The obligations of the APPLICANT shall not be discharged or affected by any amendment of the
engineering plans used for construction of the project.
3. Upon failure of the APPLICANT to perform any of the terms of the AGREEMENT, the CITY may use the
funds to complete the work and pay outstanding fees and other amounts. The APPLICANT shall have ni
duty or right to evaluate the correctness or appropriateness of the CITY'S determination that
requirements have not been to the CITY S sole satisfaction, of the terms of the Agreement.
4. The APPLICANT'S obligation to perform the work or pay fees and other amounts is not limited to the
amount of this cash surety deposit.
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It is the APPLICANT'S responsibility to notify the CITY of any changes in address, telephone
number or change of ownership of the property. It is the APPLICANT'S responsibility to arrange
for replacement of anylall financial guarantees prior to any change of ownership.
APPLICANT:
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(Print Name) ( 1
17/Wna [�,jt,r.!j, y1AwRFoEd2
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CASH SURETY DEPOSIT - DEFERRAL ASSURANCE (CONTD)
Project No. / Permit No.
PR16-000504 / DEF21003104
Project Name
Bethany Corner Short Plat
(Choose One)
❑ INDIVIDUAL ACKNOWLEDGEMENT:
State of Washington, County of King:
I certify that I know or have seen satisfactory evidence that
(APPLICANT) signed this instrument and acknowledges it to be his/her free and voluntary act for the uses
and purposes mentioned in this instrument.
® CORPORATE/LLC ACKNOWLEDGEMENT:
State of Washington, County of King
I certify that I know or have seen satisfactory evidence that DI A,vUE is the
6iAlv/rG,5wL Of 542 /JA'F'/ DC I1ra oP/-Ne 2,a Washington limited liability
company/corporation (APPLICANT), and acknowledged this instrument tobethe free and voluntary act ant
deed of said limited liability company/corporation, for the uses and purposes therein mentioned, and on
oath stated that he/she was authorized to execute this instrument on behalf of said limited liability
company/corporation.
(Notary Beal or Stamp)
� . c� NOTARY N
:;ham
oM o
N0.2
'•• F OF W PS�.�`
Received for the City of Renton By:
Dated;
Signature:'
Printed Name: 7GGLZ6' /'fwUl<HdAH`,7�R
My Appointment Expires: 061'21 / YUJcZ
(Print Name) (Signature) (Date)
Page 3 of 31 Published: 2/1/2018