HomeMy WebLinkAboutC_Aff_of_Mailing_LUA17-000169_NOA_DNS-M_Agencies_170414_v1 (2)CITY OF RENTON
DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT - PLANNING DIVISION
AFFIDAVIT OF SERVICE BY MAILING
On the lith day of April 2017,1 deposited in the mails of the United States, a sealed envelope containing
NOTICE OF APPLICATION AND PROPOSED DETERMINATION OF NON -SIGNIFICANCE -MITIGATED (DNS -M)
documents. This information was sent to:
nti
I AGENCIES I See Attached List I
(Signature of Sender):
STATE OF WASHINGTON' )
) SS
COUNTY OF KING )
1 certify that 1 know or have satisfactory evidence that Gillian Syverson signed this instrument and acknowledged
it to be his/her/their free and voluntary act for the uses and purposes mentioned in the instrument.
Dated:{ Of
Notary (Print):
My appointment expires:
Earlington Townhomes
in and for the State of Washington
PD 1ily'`
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fill,
111,2
LUA17-000169, ECF, SA -H, MOD, MOD, MOD
SAMPLE AFFIDAVIT OF SERVICE MAILING (AOS) WITH AGENCIES
For projects that have no ERC indication on NOA — page 2 isn't necessary
AGENCY (DOE) LETTER MAILING
(ERC DETERMINA71ONS)
Dept. of Ecology'
Environmental Review Section
PO Box 47703
D ,mpia, WA 98504-7703
WSDOT Northwest Region'
Attn: Ramin Pazooki
King Area Dev. Serv., MS -240
f PO Box 330310
Seattle, WA 98133-9710__
US Army Corp. of Engineers'
Seattle District Office
Attn: SEPA Reviewer
L PO Box C-3755
24
Depart. of Natural Resources
PO Box 47015
Olympia, WA 98504-7015
KC Dev. & Environmental Serv.
Attn: SEPA Section
900 Oakesdale Ave. SW
Renton, WA 98055-1219
Metro Transit
Senior Environmental Planner
Gary Kriedt
201 South Jackson Street KSC-TR-0431
Seattle. WA 98104-3856 _
Se—a le Public utilities
Real Estate Services
Title Examiner
700 Fifth Avenue, Suite 4900
PO Box 34018
Seattle, WA 98124-4018
clo Department of Ecology
3190160'" Ave SE
Bellevue, WA 98008
Duwamish Tribal Office '
4717 W Marginal Way SW
Seattle, WA 98106.1514
KC Wastewater Treatment Division '
Environmental Planning Supervisor
Ms. Shirley Marroquin
201 S. Jackson ST, MS KSC-NR-050
Seattle. WA 98104-3855
Attn, Mr. Micheal E. Nicholson
Director of Community Development
13020 SE 72" d Place
Puget Sound Energy
Municipal Liason Manager
Joe Jainga
PO Box 90868, MS: XRD-01 W
Bellevue. WA 98009.0868
Attn: Karen Walter or SEPA Reviewer
39015 – 172nd Avenue SE
Attn: Ms Melissa Calvert
39015 172n4 Avenue SE
Auburn, WA 98092.9763
Office of Archaeology & Historic
Preservation'
Attn: Stephanie Kramer
PO Box 48343
Olympia, WA 98504.8343
3 Attn: Mr. Fred Satterstrom, AICP
I Acting Community Dev. Director
220 Fourth Avenue South
Kent, WA 9803_2-5895_
i City of Tukwila
Steve Lancaster, Responsible Official
6300 Southcenter Blvd.
Tukwila, WA 98188
Note- it the Notice of Application states that it is an "Optional DNS", the marked
agencies and cities will need to be sent a copy of the checklist, PMT's, and the
notice of application
ti:10ED\Planning\Current PlanninglAdmin Docs\Secretary Manual\Secretary Manual v.2 02.15.17.doc