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NOTICE AND AFFIDAVIT OF ADU OWNER OCCUPANCY – Page 4
Corporate/LLC/Representative form of acknowledgement:
STATE OF WASHINGTON )
)
COUNTY OF KING )
On this day of , 20 _____, before me, a Notary
Public in and for the State of Washington, duly commissioned and sworn, personally
appeared ______________________________________ and said person acknowledged
that they signed this instrument, and on oath stated that he/she/they were authorized
to execute the instrument and acknowledged it as the
______________________________ of _____________________________________,
to be the free and voluntary act of such party for the uses and purposes mentioned in
the instrument.
IN WITNESS WHEREOF I have hereunder set my hand and official seal the day and year
first written above.
Signature
Print or Type Name
NOTARY PUBLIC in and for the State of Washington,
My commission expires
[Instructions: If more than one owner, add an additional notary block for each additional
owner.]
NOTICE AND AFFIDAVIT OF ADU OWNER OCCUPANCY – Page 5
EXHIBIT A TO NOTICE AND AFFIDAVIT
OF ADU OWNER OCCUPANCY
Complete legal description of the Property:
Lot 4 City of Renton Short Plat No. LUA-98-032-SHPL, As recorded
under Recording No. 20010403900006, Records of King County Auditor;
Situate in the City of Renton, County of King, State of Washington
NOTICE AND AFFIDAVIT OF ADU OWNER OCCUPANCY – Page 6
EXHIBIT B TO NOTICE AND AFFIDAVIT OF ADU
OWNER OCCUPANCY
Approved Site/Floor Plan:
Approved Permit B23002424 V5