HomeMy WebLinkAboutFUPC Lot Line Adjustment_Request for Signed Plan Sets and Minor Corrections
March 19, 2021
Shawn Pourazari
Abossein Engineering, LLC
18465 NE 68th St.
Redmond, WA 98052
SUBJECT: REQUEST FOR SIGNED PLAN SETS AND NOTICE OF LOT LINE ADJUSTMENT APPROVAL
PR17-000160 First Ukrainian Pentecostal Church Expansion, LUA19-000315, LLA
Dear Mr. Pourazari:
The City of Renton has finished reviewing your proposed lot line adjustment. Please see the attached
minor revisions. Provided the attached minor revisions are addressed, the lot line adjustment is now ready
to send the final version for recording.
Please submit five sets of original signed lot line adjustment plan sets (18”x24”) and one signed
copy of each REETA document (8 ½” x 14” or less) and one signed copy of each Deed of
Dedication (8 ½” x 14” or less) to my attention at the sixth floor counter of City Hall.
Payment of $427.50 for the recording fee(s) and $40.00 for the Courier Fee. Please pay the
enclosed invoices online at https://permitting.rentonwa.gov/#/home.
Please verify that the plan sets have been signed by all owners of record and have been notarized with an
ink stamp (not embossed). The ink stamp must be legible so that King County will promptly record the
lot line adjustment.
This decision to approve the proposed lot line adjustment is subject to a fourteen (14) day appeal period
from the date of this letter. Due to Governor Jay Inslee’s Proclamation 20-25 (“Stay Home, Stay Healthy”),
the City Clerk’s Office is working remotely. For that reason, appeals must be submitted electronically to
the City Clerk at cityclerk@rentonwa.gov. The appeal fee, normally due at the time an appeal is submitted,
will be collected at a future date. Appeals to the Hearing Examiner are governed by RMC 4-8-110 and
additional information regarding the appeal process may be obtained from the City Clerk’s Office,
cityclerk@rentonwa.gov. If the situation changes such that the City Clerk’s Office is open when you file
your appeal, you have the option of filing the appeal in person.
Shawn Pourazari
Page 2 of 2
March 19, 2021
If you have further questions regarding this project, please email me at aweihs@rentonwa.gov or call me
at (425) 430-7312.
Sincerely,
Angelea Weihs
Associate Planner
Enclosure(s): Document Recording and Courier Fee Invoice
Staff Comments and Minor Revisions
cc: Andrey Kozak/ Applicant
First Ukrainian Pentecostal Church/Owner
PLEASE TYPE OR PRINT
REAL ESTATE EXCISE TAX AFFIDAVIT
CHAPTER 82.45 RCW – CHAPTER 458-61A WAC
This form is your receipt
when stamped by cashier.
THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED
(See back of last page for instructions) Ƒ Check box if partial sale, indicate % _____sold. List percentage of ownership acquired next to each name.
1 Name
Mailing Address
City/State/Zip
Phone No. (including area code)
2 Name
Mailing Address
City/State/Zip
Phone No. (including area code) SELLER GRANTORBUYERGRANTEE3 Send all property tax correspondence to: Same as Buyer/Grantee List all real and personal property tax parcel account
numbers – check box if personal property List assessed value(s)
Name
Mailing Address
City/State/Zip
Phone No. (including area code)
4 Street address of property:
This property is located in
Check box if any of the listed parcels are being segregated from another parcel, are part of a boundary line adjustment or parcels being merged.
Legal description of property (if more space is needed, you may attach a separate sheet to each page of the affidavit)
5 Select Land Use Code(s): 7 List all personal property (tangible and intangible) included in selling
enter any additional codes:
(See back of last page for instructions)
price.
If claiming an exemption, list WAC number and reason for exemption:
WAC No. (Section/Subsection)
Reason for exemption
Type of Document
Date of Document
Gross Selling Price $
*Personal Property (deduct) $
Exemption Claimed (deduct) $
Taxable Selling Price $
Excise Tax : State $
Local $
*Delinquent Interest: State $
Local $
*Delinquent Penalty $
Subtotal $
*State Technology Fee $
*Affidavit Processing Fee $
Total Due $
A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX
*SEE INSTRUCTIONS
YES NO
Was the seller receiving a property tax exemption or deferral under
chapters 84.36,84.37, or 84.38 RCW (nonprofit organization, senior
citizen, or disabled person, homeowner with limited income)?
6 YES NO
Is this property designated as forest land per chapter 84.33 RCW?
Is this property classified as current use (open space, farm and
agricultural, or timber) land per chapter 84.34 RCW?
Is this property receiving special valuation as historical property
per chapter 84.26 RCW?
If any answers are yes, complete as instructed below.
(1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE)
NEW OWNER(S): To continue the current designation as forest land or
classification as current use (open space, farm and agriculture, or timber) land,
you must sign on (3) below. The county assessor must then determine if the
land transferred continues to qualify and will indicate by signing below. If the
land no longer qualifies or you do not wish to continue the designation or
classification, it will be removed and the compensating or additional taxes will
be due and payable by the seller or transferor at the time of sale. (RCW
84.33.140 or RCW 84.34.108). Prior to signing (3) below, you may contact
your local county assessor for more information.
This land does does not qualify for continuance.
DEPUTY ASSESSOR DATE
(2) NOTICE OF COMPLIANCE (HISTORIC PROPERTY)
NEW OWNER(S): To continue special valuation as historic property,
sign (3) below. If the new owner(s) does not wish to continue, all
additional tax calculated pursuant to chapter 84.26 RCW, shall be due and
payable by the seller or transferor at the time of sale.
(3) OWNER(S) SIGNATURE
PRINT NAME
8 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
Signature of
Grantor or Grantor’s Agent
Name (print)
Date & city of signing:
Signature of
Grantee or Grantee’s Agent
Name (print)
Date & city of signing:
Perjury: Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum term of not more than five years, or by
a fine in an amount fixed by the court of not more than five thousand dollars ($5,000.00), or by both imprisonment and fine (RCW 9A.20.020 (1C)).
REV 84 0001a (09/06/17)THIS SPACE - TREASURER’S USE ONLY COUNTY TREASURER
✔
First Ukrainian Pentecostal Church
3811 NE 21st Street
Renton, WA 98056
City of Renton, a Municipal Corporation
1055 S Grady Way
Renton, WA 98057
(425) 430-6400
✔
Portion of Parcel 0423059237
3811 NE 21st Street Renton WA 98056
Renton
THAT PORTION OF THE EAST HALF OF THE EAST HALF OF THE NORTHWEST QUARTER OF THE NORTHEAST QUARTER OF
THE SOUTHEAST QUARTER OF SECTION 4, TOWNSHIP 23 NORTH, RANGE 5 EAST, W.M., IN KING COUNTY, WASHINGTON,
LYING NORTHERLY OF THE EASTERLY PRODUCTION OF THE SOUTH LINE OF LOT 4 OF ROSE HAVEN, ACCORDING TO THE
PLAT THEREOF RECORDED IN VOLUME 63 OF PLATS, PAGE 10, IN KING COUNTY, WASHINGTON.
(SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF)
45 - Highway and street right of way
✔
None
✔458-61A-205(4)
✔
✔
Dedication of Street Right of Way
Deed of Dedication
0.00
0.00
0.000.0050
0.00
5.00
10.00
Ivan Feltsan
PLEASE TYPE OR PRINT
REAL ESTATE EXCISE TAX AFFIDAVIT
CHAPTER 82.45 RCW – CHAPTER 458-61A WAC
This form is your receipt
when stamped by cashier.
THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED
(See back of last page for instructions) Ƒ Check box if partial sale, indicate % _____sold. List percentage of ownership acquired next to each name.
1 Name
Mailing Address
City/State/Zip
Phone No. (including area code)
2 Name
Mailing Address
City/State/Zip
Phone No. (including area code) SELLER GRANTORBUYERGRANTEE3 Send all property tax correspondence to: Same as Buyer/Grantee List all real and personal property tax parcel account
numbers – check box if personal property List assessed value(s)
Name
Mailing Address
City/State/Zip
Phone No. (including area code)
4 Street address of property:
This property is located in
Check box if any of the listed parcels are being segregated from another parcel, are part of a boundary line adjustment or parcels being merged.
Legal description of property (if more space is needed, you may attach a separate sheet to each page of the affidavit)
5 Select Land Use Code(s): 7 List all personal property (tangible and intangible) included in selling
enter any additional codes:
(See back of last page for instructions)
price.
If claiming an exemption, list WAC number and reason for exemption:
WAC No. (Section/Subsection)
Reason for exemption
Type of Document
Date of Document
Gross Selling Price $
*Personal Property (deduct) $
Exemption Claimed (deduct) $
Taxable Selling Price $
Excise Tax : State $
Local $
*Delinquent Interest: State $
Local $
*Delinquent Penalty $
Subtotal $
*State Technology Fee $
*Affidavit Processing Fee $
Total Due $
A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX
*SEE INSTRUCTIONS
YES NO
Was the seller receiving a property tax exemption or deferral under
chapters 84.36,84.37, or 84.38 RCW (nonprofit organization, senior
citizen, or disabled person, homeowner with limited income)?
6 YES NO
Is this property designated as forest land per chapter 84.33 RCW?
Is this property classified as current use (open space, farm and
agricultural, or timber) land per chapter 84.34 RCW?
Is this property receiving special valuation as historical property
per chapter 84.26 RCW?
If any answers are yes, complete as instructed below.
(1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE)
NEW OWNER(S): To continue the current designation as forest land or
classification as current use (open space, farm and agriculture, or timber) land,
you must sign on (3) below. The county assessor must then determine if the
land transferred continues to qualify and will indicate by signing below. If the
land no longer qualifies or you do not wish to continue the designation or
classification, it will be removed and the compensating or additional taxes will
be due and payable by the seller or transferor at the time of sale. (RCW
84.33.140 or RCW 84.34.108). Prior to signing (3) below, you may contact
your local county assessor for more information.
This land does does not qualify for continuance.
DEPUTY ASSESSOR DATE
(2) NOTICE OF COMPLIANCE (HISTORIC PROPERTY)
NEW OWNER(S): To continue special valuation as historic property,
sign (3) below. If the new owner(s) does not wish to continue, all
additional tax calculated pursuant to chapter 84.26 RCW, shall be due and
payable by the seller or transferor at the time of sale.
(3) OWNER(S) SIGNATURE
PRINT NAME
8 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
Signature of
Grantor or Grantor’s Agent
Name (print)
Date & city of signing:
Signature of
Grantee or Grantee’s Agent
Name (print)
Date & city of signing:
Perjury: Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum term of not more than five years, or by
a fine in an amount fixed by the court of not more than five thousand dollars ($5,000.00), or by both imprisonment and fine (RCW 9A.20.020 (1C)).
REV 84 0001a (09/06/17)THIS SPACE - TREASURER’S USE ONLY COUNTY TREASURER
✔
First Ukrainian Pentecostal Church
3811 NE 21st Street
Renton, WA 98056
City of Renton, a Municipal Corporation
1055 S Grady Way
Renton, WA 98057
(425) 430-6400
✔
Portion of Parcel 0423059068
3810 NE 19TH Street Renton WA 98056
Renton
THE EAST HALF OF THE EAST HALF OF THE NORTHWEST QUARTER OF THE NORTHEAST QUARTER OF THE SOUTHEAST
QUARTER OF SECTION 4, TOWNSHIP 23 NORTH, RANGE 5 EAST, W.M., IN KING COUNTY, WASHINGTON;
EXCEPT THE SOUTH 15 FEET THEREOF LYING WITHIN THE RIGHT OF WAY OF SOUTHEAST 106TH STREET; ALSO
EXCEPT THAT PORTION THEREOF LYING NORTHERLY OF THE EASTERLY PRODUCTION OF THE SOUTH LINE OF LOT 4,
ROSE HAVEN, ACCORDING TO THE PLAT THEREOF RECORDED IN VOLUME 63 OF PLATS, PAGE 10, IN KING COUNTY, WA.
(SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF)
45 - Highway and street right of way
✔
None
✔458-61A-205(4)
✔
✔
Dedication of Street Right of Way
Deed of Dedication
0.00
0.00
0.000.0050
0.00
5.00
10.00
Ivan Feltsan
/DEEDofDEDICATION.doc\ SMT Page 1 of 4 FORM 04 0001/bh
Return Address:
City Clerk’s Office
City of Renton
1055 South Grady Way
Renton, WA 98057
DEED OF DEDICATION Property Tax Parcel Number:
Project File #: Street Intersection:
Reference Number(s) of Documents assigned or released: Additional reference numbers are on page _____.
Grantor(s): Grantee:
1.
2.
City of Renton, a Washington Municipal Corporation
LEGAL DESCRIPTION: (Abbreviated or full legal must go here. Additional legal on page_______)
The Grantor, _________________________, for and in consideration of mutual benefits conveys, quit claims,
and dedicates to the Grantee, the City of Renton, the above described real estate situated in the County of
King, State of Washington.
IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year as written below.
Grantor(s):
Dated:
INDIVIDUAL FORM OF ACKNOWLEDGMENT
STATE OF WASHINGTON ) SS
COUNTY OF KING ) I certify that I know or have satisfactory evidence that ______________________
Notary Seal must be within box ________________________________________ signed this instrument and
acknowledged it to be his/her/their free and voluntary act for the uses and
purposes mentioned in the instrument.
Notary Public in and for the State of Washington
Notary (Print)_____________________________________
My appointment expires:____________________________
Dated:
THAT PORTION OF THE EAST HALF OF THE EAST HALF OF THE NORTHWEST QUARTER OF THE NORTHEAST QUARTER
OF THE SOUTHEAST QUARTER OF SECTION 4, TOWNSHIP 23 NORTH, RANGE 5 EAST, W.M., IN KING COUNTY,
WASHINGTON, LYING NORTHERLY OF THE EASTERLY PRODUCTION OF THE SOUTH LINE OF LOT 4 OF ROSE HAVEN,
ACCORDING TO THE PLAT THEREOF RECORDED IN VOLUME 63 OF PLATS, PAGE 10, IN KING COUNTY, WASHINGTON.
0423059237
NE 21ST ST
FIRST UKRAINIAN PENTECOSTAL CHURCH
3
/DEEDofDEDICATION.doc\ SMT Page 2 of 4 FORM 04 0001/bh
REPRESENTATIVE FORM OF ACKNOWLEDGMENT
STATE OF WASHINGTON ) SS
COUNTY OF KING ) I certify that I know or have satisfactory evidence that ______________________
Notary Seal must be within box ________________________________________ signed this instrument and
acknowledged it to be his/her/their free and voluntary act for the uses and
purposes mentioned in the instrument.
Notary Public in and for the State of Washington
Notary (Print)_____________________________________
My appointment expires:____________________________
Dated:
CORPORTATE FORM OF ACKNOWLEDGMENT
STATE OF WASHINGTON ) SS
COUNTY OF KING ) I certify that I know or have satisfactory evidence that ______________________
Notary Seal must be within box ________________________________________ signed this instrument and
acknowledged it to be his/her/their free and voluntary act for the uses and
purposes mentioned in the instrument.
Notary Public in and for the State of Washington
Notary (Print)_____________________________________
My appointment expires:____________________________
Dated:
Accepted by the City of Renton:
By: ________________________________
Mayor
Attest:
By: ______________________________
City Clerk
/DEEDofDEDICATION.doc\ SMT Page 3 of 4 FORM 04 0001/bh
Exhibit A
Legal Description
Project:
WO#
PID
GRANTOR:
Street:
0423059237
NE 21ST ST
THE NORTH 20.00 FEET OF THE FOLLOWING DESCRIBED PARCEL:
THAT PORTION OF THE EAST HALF OF THE EAST HALF OF THE NORTHWEST QUARTER OF THE
NORTHEAST QUARTER OF THE SOUTHEAST QUARTER OF SECTION 4, TOWNSHIP 23 NORTH, RANGE
5 EAST, WILLAMETTE MERIDIAN, IN KING COUNTY, WASHINGTON, LYING NORTHERLY OF THE
EASTERLY PRODUCTION OF THE SOUTH LINE OF LOT 4 OF ROSE HAVEN, ACCORDING TO THE PLAT
THEREOF, RECORDED IN VOLUME 63 OF PLATS, PAGE 10, IN KING COUNTY, WASHINGTON.
SITUATE IN THE CITY OF RENTON, COUNTY OF KING,
STATE OF WASHINGTON.
/DEEDofDEDICATION.doc\ SMT Page 4 of 4 FORM 04 0001/bh
Map Exhibit
/DEEDofDEDICATION.doc\ SMT Page 1 of 4 FORM 04 0001/bh
Return Address:
City Clerk’s Office
City of Renton
1055 South Grady Way
Renton, WA 98057
DEED OF DEDICATION Property Tax Parcel Number:
Project File #: Street Intersection:
Reference Number(s) of Documents assigned or released: Additional reference numbers are on page _____.
Grantor(s): Grantee:
1.
2.
City of Renton, a Washington Municipal Corporation
LEGAL DESCRIPTION: (Abbreviated or full legal must go here. Additional legal on page_______)
The Grantor, _________________________, for and in consideration of mutual benefits conveys, quit claims,
and dedicates to the Grantee, the City of Renton, the above described real estate situated in the County of
King, State of Washington.
IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year as written below.
Grantor(s):
Dated:
INDIVIDUAL FORM OF ACKNOWLEDGMENT
STATE OF WASHINGTON ) SS
COUNTY OF KING ) I certify that I know or have satisfactory evidence that ______________________
Notary Seal must be within box ________________________________________ signed this instrument and
acknowledged it to be his/her/their free and voluntary act for the uses and
purposes mentioned in the instrument.
Notary Public in and for the State of Washington
Notary (Print)_____________________________________
My appointment expires:____________________________
Dated:
THE EAST HALF OF THE EAST HALF OF THE NORTHWEST QUARTER OF THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER OF
SECTION 4, TOWNSHIP 23 NORTH, RANGE 5 EAST, W.M., IN KING COUNTY, WASHINGTON;
EXCEPT THE SOUTH 15 FEET THEREOF LYING WITHIN THE RIGHT OF WAY OF SOUTHEAST 106TH STREET; ALSO
EXCEPT THAT PORTION THEREOF LYING NORTHERLY OF THE EASTERLY PRODUCTION OF THE SOUTH LINE OF LOT 4, ROSE HAVEN,
ACCORDING TO THE PLAT THEREOF RECORDED IN VOLUME 63 OF PLATS, PAGE 10, IN KING COUNTY, WASHINGTON.
0423059068
NE 19TH ST
FIRST UKRAINIAN PENTECOSTAL CHURCH
3
/DEEDofDEDICATION.doc\ SMT Page 2 of 4 FORM 04 0001/bh
REPRESENTATIVE FORM OF ACKNOWLEDGMENT
STATE OF WASHINGTON ) SS
COUNTY OF KING ) I certify that I know or have satisfactory evidence that ______________________
Notary Seal must be within box ________________________________________ signed this instrument and
acknowledged it to be his/her/their free and voluntary act for the uses and
purposes mentioned in the instrument.
Notary Public in and for the State of Washington
Notary (Print)_____________________________________
My appointment expires:____________________________
Dated:
CORPORTATE FORM OF ACKNOWLEDGMENT
STATE OF WASHINGTON ) SS
COUNTY OF KING ) I certify that I know or have satisfactory evidence that ______________________
Notary Seal must be within box ________________________________________ signed this instrument and
acknowledged it to be his/her/their free and voluntary act for the uses and
purposes mentioned in the instrument.
Notary Public in and for the State of Washington
Notary (Print)_____________________________________
My appointment expires:____________________________
Dated:
Accepted by the City of Renton:
By: ________________________________
Mayor
Attest:
By: ______________________________
City Clerk
/DEEDofDEDICATION.doc\ SMT Page 3 of 4 FORM 04 0001/bh
Exhibit A
Legal Description
Project:
WO#
PID
GRANTOR:
Street:
0423059068
NE 19TH ST
A PORTION OF THE FOLLOWING DESCRIBED PARENT PARCEL:
THE EAST HALF OF THE EAST HALF OF THE NORTHWEST QUARTER OF THE NORTHEAST QUARTER
OF THE SOUTHEAST QUARTER OF SECTION 4, TOWNSHIP 23 NORTH, RANGE 5 EAST, W.M., IN KING
COUNTY, WASHINGTON;
EXCEPT THE SOUTH 15 FEET FOR ROAD AND EXCEPT THAT PORTION THEREOF LYING NORTHERLY
OF THE EASTERLY PRODUCTION OF THE SOUTH LINE OF LOT(S) 4 ROSE HAVEN, ACCORDING TO
THE PLAT THEREOF RECORDED IN VOLUME 63 OF PLATS, PAGE(S) 10, RECORDS OF KING COUNTY,
WASHINGTON;
SAID PORTION BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT THE SOUTHEAST CORNER OF SAID PARENT PARCEL;
THENCE NORTH 88°14'43" WEST ALONG THE SOUTH LINE OF SAID PARENT PARCEL 163.46 FEET TO
THE WEST LINE OF SAID PARENT PARCEL;
THENCE NORTH 01°04'24" EAST ALONG SAID WEST LINE 14.40 FEET;
THENCE SOUTH 88°11'58" EAST 163.46 FEET TO THE EAST LINE OF SAID PARENT PARCEL;
THENCE SOUTH 01°03'19" WEST ALONG SAID EAST LINE 14.27 FEET TO THE POINT OF BEGINNING.
SITUATE IN THE CITY OF RENTON, COUNTY OF KING, STATE OF WASHINGTON.
/DEEDofDEDICATION.doc\ SMT Page 4 of 4 FORM 04 0001/bh
Map Exhibit