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Created:May 26, 2022 08:47:53 -8:00
Pages:1
Remote Notary:Yes / State: WA
Renton_Affidavit_Sign_Installation_Blank.pdf
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DocVerify ID: 577B234F-865F-411B-84BA-04399E483239
www.docverify.com 04399E483239 DE
LAE
SD
OCVE R IF YE-Signature 1: JeffreyT Bernhardt (JTB)
May 26, 2022 08:58:07 -8:00 [9710DFFEC8D3] [198.49.222.20]
jeff.bernhardt@kingcounty.gov (Principal) (Personally Known)
E-Signature Summary
E-Signature Notary: Julie Sanders (JMS)
May 26, 2022 08:58:07 -8:00 [13778E02A9A4] [198.49.222.20]
jsanders@kingcounty.gov
I, Julie Sanders, did witness the participants named above electronically
sign this document.DE
LAE
SD
OCVE R IF Y
DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
7
H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Public Information Sign Handout.docx Rev. 02/2017
AFFIDAVIT OF INSTALLATION OF
PUBLIC INFORMATION SIGN
Planning Division
1055 South Grady Way, Renton, WA 98057
Phone: 425-430-7200 | www.rentonwa.gov
STATE OF WASHINGTON )
SS
COUNTY OF KING )
1. I, ____________________________________, certify under penalty of perjury under
the laws of the State of Washington that the foregoing is true and correct, being first
duly sworn on oath, deposes and says:
2. On the ________ day of _________________________, 20_______, I installed ________
public information sign(s) on the property located at _____________________________
for the following project:
Project Name
Owner Name
3. I have attached a copy of the neighborhood detail map marked with an “X” to indicate
the location of the installed sign.
4. This/these public information sign(s) was/were constructed and installed in location s in
conformance with the requirements of Chapter 8 Title 4 of Renton Municipal Code and
the City’s “Public Information Signs Installation” handout package.
Installer Signature
SUBSCRIBED AND SWORN to before me this _____ day of _______________, 20_____.
NOTARY PUBLIC in and for the State of Washington,
residing at .
My commission expires on
DocVerify ID: 577B234F-865F-411B-84BA-04399E483239
www.docverify.com577B234F-865F-411B-84BA-04399E483239 --- 2022/05/26 08:47:53 -8:00 --- Remote NotaryPage 1 of 1 104399E483239
26th May 22
Tacoma
5/31/2025
Notarial act performed by audio-visual communication
9710DFFEC8D3
Signed on 2022/05/26 08:58:07 -8:00
JeffreyT Bernhardt
122May13th
JeffreyT Bernhardt
DocVerifyJULIE SANDERS
NOTARY PUBLIC STATE OF WASHINGTON
Commission # 192651
My Commission Expires May 31, 2025
13778E02A9A4Notary Stamp 2022/05/26 08:58:07 PST
13778E02A9A4
Signed on 2022/05/26 08:58:07 -8:00