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AFFIDAVIT OF INSTALLATION OF
PUBLIC INFORMATION SIGN
Planning Division
1055 South Grady Way, Renton, WA 98057
Phone: 425-430-7200 Fax: 425-430-7231
STATE OF WASHINGTON )
) SS
COUNTY OF KING )
GCQIl".t£e-/. i)UJ) C tj/
duly sworn on oath, deposes and says:
SFP , '/ "':1.; i',
being first
1. On the 16t:A..Day of 5e::,P/ , 20/.5, I installed / public
information sign(s) and plastic flyer box on the property located at
1.11' !JUH'A(; ~ ~(/E F~ for the following project:
5f!orzr f'trfT t-tT It (4S5/0' C~J Vt:
Project Name
Owner Name
2. have attached a copy of the neighborhood detail map marked with an "X" to
indicate the location of the installed sign.
3. This/these public information sign(s) was/were constructed and installed in locations
in conformance with the requirements of Chapter 7 Title 4 of Renton Municipal Code
and the City's "Public Information Signs Installation" han t pa age.
SUBSCRIBED,{W,IM~W-?RN to before me this /1p<i41dayof ,~plfVllmr ,20...1.5:.....
~,'...... ESCu.iillll J JI. • /'
§ ~'t-: ~':"""''''1t't tl~ II~ ~ tJ ~ i .1~ ..... ~~ \ NOTARY PUBLIC in and for the State of Washington, :: II ~·~P).1 .. residing at »'f«f se .ZI;t>+t. -PL .&lank (AILA i " ~i1
\ ~~ ??t\.j §. My commission expires on b -/ q -It." ~,~, .... o" .. ~;;
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H : \ CE D\Data \Forms~ T em plates \Self -H el p Hand outs\PI a n ni n g\p u bs ign .doc Rev; 02/2015
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PORTIONS Of N ..... 1/4/, NE 114, AND Sf: 1/4, SECTION 16 T23N R5£, Vfl
SHORT PLAT SITE MAP
OF LOT A CASSIDY COVE PLAT
KI~IG COUNTY DEPARTNENT OF" TRI>.NSPORTATIDN
ROAD SERV[CE DIVISION -SURVEY UNIT
LSS MONROE AVE NE, RENTON, "<IA 98056
(206) 477-1173 FAX (206)296-7719
JOB NO. 02067 1123946
GRAPHrC SCALE
~ I LDT 5
(RI ...... 1
I ;l'Ieh .. 25G rl
RECEIPT EG00043540
BILLING CONTACT
Steve Rizika
King County
500 4th Ave, Room 830
Seattle, WA 98104
REFERENCE NUMBER FEE NAME
LUA 15-000676 PLAN -Modification
PLAN -Short Plat Fee
." .
Technology Fee
Printed On: September 17, 2015 Prepared By: Clark Close
---------"l{enton ®
000'()OOOOO,011'.34""81.00.000
000.000000.007.345.81.01.000
503.000000.004.322.10.00.000
TRANSACTION
TYPE
Fee Payment
$150.00
Fee Payment
$2.000,00
Fee Payment
$64.50
.
10555 Grady Way, Renton, WA 98057
•......
Transaction Date: September 17, 2015
PAYMENT
METHOD
'"''
Check #14911098
Check #14911098
Check #14911098
.. '
sue TOTAL
TOTAL
AMOUNT PAID
$150,00
..
$2.000.00
...L
• $64.50
$2,214.50
$2.214.50
Page 1 of 1
t; Finance and Business Operations Division
Department of Execu' Services
401 Fifth Avenue, MJ: :-E5-0323 Warrant No. 14911098
KingCounty Seattle, WA. 98104-1818
DATE 11-AUG-2015 VENDOR NAME CITY OF RENTON VENDOR NO. 2248
INVOICE NUMBER INV . DATE DESCRIPTION DISCOUNT NET AMOUNT
n~ roN SHOPS SHORT P1.AT 27-JUL-1S IReal Estate Services $0.00 $2_214.50
PLEASE DETACH AND RETAIN THIS STATEMENT AS .;R RECORD OF PAYMENT TOTA I $0.00 I $2,214.50