HomeMy WebLinkAboutBOS Renton Mini LLCDepartment ofRevenueWashingtonState
REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt
PLEASE TYPE OR PRINT C1-LkPTER 82.45 RCW —CHAPTER 458-61A WAC when stamped by cashier.
TillS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED
(Sce buck of last page for instructions)
Check box if partial sale,indicate %.004 sold.List percentaee of ownership acquired next to each name.
U Name U Name CITY OF RENTON
RAYMOND C.SPENCER (MANAGING MEMBER)
MailingAddress 133 E LAKE SAMMAMISH LN NE MailingAddress 1055 S.GRADY WAY
City/State/Zip SAMMAMISH,WA 98074 City/State/Zip RENTON WA 98057
Phone No.(incitiding area code)2069494962 Phone No.(including area code)_________________________________________
A List all real and personal property tax parcel accountSendallpropertytaxcorrespondenceto:Same as Buyer/Grantee .List assessed value(s)numbers —cheek box ifpersonal property
Name
Mailing Address
City/State/Zip
Phone No.(including area code)___________________________________________
Street address of property:4815 NE 4TH ST..RENTON,WA 98059
This property is located in Select Location
Check box ifany 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)
U Select Land Use Code(s):
Select Land Use Codes
enter any additional codes:________________________________
(See back of last page for instructions)
YES
Was the seller receiving a property tax exemption or deferral under t1
chapters 84.36,84.37,or 84.38 RCW (nonprofit organization,senior
citizen,or disabled person,homeowner with limited income)?
NO
0
U YES NO
Is this property designated as forest land per chapter 84.33 RCW?
Is this property classified as currentuse (open space,farm and
agricultural,or timber)land per chapter 84.34?
Is this property receiving special valuation as historical property []E]
per chapter 84.26 RCV?
Ifany answers are yes,complete as instructed below.
(I)NOTICEOF 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.Ifthe
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 ofsale.(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 Qdoes U does not qualify for continttance.
DEPUTY ASSESSOR DATE
(2)NOTICEOF COMPLIANCE(l-HSTORIC 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 8426 RCW,shall be due and
payable by the seller or transferor at the time of sale.
(3)OWNER(S)SIGNATURE
List all personal property (tangible and intangible)included in selling -
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
_______________________
I1TTE1E FOREGOING IS TRUE AND CORRECT.
Signature of
Grantee or Grantee’s Agent
Name (print)
Date &city of signing:
U El
00
Gross Selling Price $___________
*personal Property (deduct)$___________
Exemption Claimed (deduct)$__________
Taxable Selling Price $__________
Excise Tax :State $__________
0.0000 ILocal S
________
*Delinquent Interest:State $___________
Local $___________
*Delinquent Penalty 5
_________
Subtotal $0.00
0.00
0.00
0.00
PRINT NAME
tState Technology fee $5.00
*Affidavit Processing Fee $____________________________________
Total Due $10.00
A MINIMUM OF $10.00 IS DUE CX FEE(S)AND/OR TAX
*SEE INSTRUCTIONS
Date &ctty of slenine:•
I’—•-I
Perjury:Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum term ofnot more than five years,or by
a fine in an amount fixed by the court ofnot more than five thousand dollars ($5,000.00),or by both imprisonment and fine (RCW 9A.20.020 (1C)).
REV 840001a (09/14/16)THIS SPACE -TREASURER’S USE ONLY COUNTY ASSESSOR
EXHIBIT A
(LEGAL DESCRIPTION RIGHT-OF-WAY DEDICATION)
THE SOUTH 1.50 FEET OF THE NORTH 43.50 FEET OF THE EAST 230 FEET OF THE NORTH HALF
OF THE NORTHEAST QUARTER OF THE NORTHEAST QUARTER OF THE NORTHWEST QUARTER
OF SECTION 15,TOWNSHIP 23 NORTH,RANGE 5 EAST,W.M.,IN KING COUNTY,WASHINGTON,
DESCRIBED AS FOLLOWS:
COMMENCING AT THE NORTHEAST CORNER OF THE NORTHEAST QUARTER OF THE
NORTHEAST QUARTER OF THE NORTHWEST QUARTER OF SAID SECTION 15;
THENCE SOUTH 00°3140’WEST,ALONG THE EAST LINE OF SAID SUBDIVISION FOR A
DISTANCE OF 42.01 FEET TO A POINT 42.00 FEET SOUTH OF THE NORTH LINE OF SAID
SUBDIVISION AND THE POINT OF BEGINNING;
THENCE CONTINUING SOUTH 00°31’40’WEST,1.50 FEET TO A POINT ON THE SOUTH LINE OF
THE NORTH 43.50 FEET OF SAID SUBDIVISION;
THENCE NORTH 88°02’59’WEST PARALLEL WITH THE NORTH LINE OF SAID SUBDIVISION FOR A
DISTANCE OF 230.07 FEET TO THE WEST LINE OF THE EAST 230.00 FEET OF SAID SUBDIVISION;
THENCE NORTH 00°31’40’EAST,ALONG SAID WEST LINE FOR A DISTANCE OF 1.50 FEET TO
THE SOUTH LINE OF THE NORTH 42.00 FEET OF SAID SUBDIVISION;
THENCE SOUTH 88°02’59”EAST,ALONG SAID SOUTH LINE FOR A DISTANCE OF 230.07 FEET TO
THE POINT OF BEGINNING.
Project Name:Urban Self Storage,Inc.
September 22,2016
OBH
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Departmentof
(Y
Revenue
Washtngton State REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt
PLEASE TYPE OR PRINT CHAPTER 82.45 RCW —CHAPTER 458-6 IA WAC when stamped by cashier.
THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED
(Sec back of last page for instructions)
‘“if partial sale.indicate %0.004 sold.List percentaae of ownership acpuired next to each name.
U Name RENTON MINI II.LLC.U NameCITY OF RENTON
RAYMOND C.SPENCER (MANAGING MEMBER)
Mailing Addressl33 E LAKE SAMMAMISH LN NE MailingAddresslOS5 S.GRADY WAY
City/State/ZIpSAMMAMISH,WA 98074 City/State/Zip RENTON WA 98057
Phone No.(including area code)(206)949—4962 Phone No.(incltiding area code)______________________________________
U List all real and personal property tax parcel accountSendallpropertytaxcorrespondenceto:‘Same as Buyer/Grantee .List assessed value(s)numbers —cheek box if personal property
Name $2,157.00
Mailing Address El
City/State/Zip 1=1
Phone No.(including area code)________________________________________1=1
•Street address of property:4815 NE 4TH ST.,RENTON,WA 98059
This property is located in Renton
0 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)
THE SOUTH 1.50 FEET OF THE NORTH 43.50 FEET OF THE EAST 230 FEET OF THE NORTH HALF OF THE NORTHEAST
QUARTER OF THE NORTHEAST QUARTER OF THE NORTHWEST QUARTER OF SECTION 15,TOWNSHIP 23 NORTH,RANGE 5
EAST,W.M.,IN KING COUNTY,WASHINGTON,DESCRIBED AS FOLLOWS:(SEE ADDITIONAL ATTACHED SHEET)
U Select Land Use Code(s):
‘99 -Other undeveloped land []
enter any additional codes:____________________________________
(See back of last page for instructions)
YES NO
Was the seller receiving a property tax exemption ordeferral tinder []2]
chapters 84.36,84.37,or 84.38 RCW (nonprofit organization,senior
citizen,or disabled person,homeowner with limited income)?
U YES NO
Is this property designated as forest land per chapter 84.33 RC\t’?
Is thisproperty classified as currentuse (open space,faint and
agricttltural,or timber)land per chapter 84.34 RC’W?
Is thisproperty receiving special valuation as historical property
per chapter 84.26 RCW?
Ifany answers are yes,complete as instructed below.
(1)NOTICE OF CONTINUANCE (FOREST LANDOR CURRENTUSE)
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
84.33.110 or RCW 84.34.108).Prior to signing (3)below,you may contact
your local county assessor for more information.
This land J does jJ does not qualify for continuance.
List all personal property (tangible and intangible)included in selling
price.
$
$
S
S 0.00
S 0.00
$0.00
$
S
$
$0.00
$5.00
$
S 10.00
A MINIMUM OF $10.00 IS DUE IN FEE(S)AND/OR TAX
*SEE INSTRUCTIONS
00
p
If claiming an exemption,list WAC number and reason for exemption:
WAC No.(Section/Subsection)
__________________________________
Reason for exemption
Type of Document
Date of Document
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
Gross Selling Price
*personal Property (deduct)
Exemption Claimed (deduct)
Taxable Selling Price
Excise Tax :State
0.0050 Local
*Delinquent Interest:State
Local
*Delinquent Penalty
Subtotal
*State Technology F cc
*Aftidavit Processing Fee
Total Due
PRINT NAME
<i..c.F.R1’4fY UN ER ‘ALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
Signature of ‘Signature of
Grantor or j3ntor’s Agen
-,,Grantee or Grantee’s Agent
Name (rint)4(iA ‘SE IJA iJCi%kcssfcName (print)
...t $%Yr “-‘i i ‘:u:t.-.—
Date &city ofsigning’I.
.
t.,4\Date &city of signing:
Perjury:Perjt.tiy is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum lerm ofnot 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 OA.20.020 (I C’)).
REV 84 000 Ia (09/14/16)THIS SPACE -TREASURER’S USE ONLY COUNTY TREASURER
EXHIBIT A
(LEGAL DESCRIPTION RIGHT-OF-WAY DEDICATION)
THE SOUTH 1.50 FEET OF THE NORTH 43.50 FEET OF THE EAST 230 FEET OF THE NORTH HALF
OF THE NORTHEAST QUARTER OF THE NORTHEAST QUARTER OF THE NORTHWEST QUARTER
OF SECTION 15,TOWNSHIP 23 NORTH,RANGE 5 EAST,W.M.,IN KING COUNTY,WASHINGTON,
DESCRIBED AS FOLLOWS:
COMMENCING AT THE NORTHEAST CORNER OF THE NORTHEAST QUARTER OF THE
NORTHEAST QUARTER OF THE NORTHWEST QUARTER OF SAID SECTION 15;
THENCE SOUTH 00°31’40”WEST,ALONG THE EAST LINE OF SAID SUBDIVISION FOR A
DISTANCE OF 42.07 FEET TO A POINT 42.00 FEET SOUTH OF THE NORTH LINE OF SAID
SUBDIVISION AND THE POINT OF BEGINNING;
THENCE CONTINUING SOUTH 00°31’40”WEST,1.50 FEET TO A POINT ON THE SOUTH LINE OF
THE NORTH 43.50 FEET OF SAID SUBDIVISION;
THENCE NORTH 88°02’Sg”WEST PARALLEL WITH THE NORTH LINE OF SAID SUBDIVISION FOR A
DISTANCE OF 230.07 FEET TO THE WEST LINE OF THE EAST 230.00 FEET OF SAID SUBDIVISION;
THENCE NORTH 00°31’40”EAST,ALONG SAID WEST LINE FOR A DISTANCE OF 1.50 FEET TO
THE SOUTH LINE OF THE NORTH 42.00 FEET OF SAID SUBDIVISION;
THENCE SOUTH 88°02’59’EAST,ALONG SAID SOUTH LINE FOR A DISTANCE OF 230.07 FEET TO
THE POINT OF BEGINNING.
Project Name:Urban Self Storage,Inc.
September 22,2016
OBH
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&,Ji7e,<&j,ç iZ1 7L(-,cIO
Dirt and Utility Contractor rT O.
Contractor Name:J3f 4ff 7iq SVZiic-I
Street:3tS’)/-;L g
City,State Zip p7,’Altt-(&)‘?cS’012_
Phone:4ZS -
Return Address:
City Clerk’s Office
City of Renton
1055 South Grady Way
Renton,WA 98057
DEED OF DEDICATION Property Tax Parcel Number:1523059002
Project File #:Street Intersection:NE 4TH ST.&FIELD PL.NE
Reference Number(s)of Documents assigned or released:Additional reference numbers are on page
Gtftrtf MINI II LL Grantee:
1..City of Renton,a Washington Municipal Corporation
2.
LEGAL DESCRIPTION:(Abbreviated orfull legal must go here.Additional legal on page 3
THE SOUTH 1.50 FEET OF THE NORTH 43.50 FEET OF THE EAST 230 FEET OF THE NORTH
HALF OF THE NORTHEAST QUARTER OF THE NORTHEAST QUARTER OF THE NORTHWEST
QUARTER OF SECTION 15,TOWNSHIP 23 NORTH,RANGE 5 EAST,W.M.,IN KING COUNTY,
WASHINGTON,DESCRIBED AS FOLLOWS:
The Grantor,RENTON MINI II.LCC ,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.
,4antor(s)Y
AAL
___________
LL
t22 (,
_______________
INDIVIDUAL FORM OFACKNOWLEDGMENT
STATE OF WASHINGTON )
COUNTYOFKING )
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:
/DEEDofDEDICATION.doc\SMT Page 1 of 4 FORM 04 0001/bh
REPRESENTATIVE FORM OF ACKNOWLEDGMENT
STATE OF WASHINGTON )ss
COUNTYOF KING
I certify that I know or have satisfactory evidence that
________________________
Ro__j ry-jrc’.c(C zr%(éC 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)tt1_u
My appointment expires:U
Dated:I )I’,ii‘((I
CORPORTATE FORM OFACKNOWLEDGMENT
STATE OF WASHINGTON )5
COUNTYOF 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 2 of 4 FORM 04 0001/bh
Project;
Exhibit A WO#
PIDLegalDescriptionGRANTOR:
Street:
(LEGAL DESCRIPTION RIGHT-OF-WAY DEDICATION)
THE SOUTH 1.50 FEET OF THE NORTH 43.50 FEET Of THE EAST 23.0 FEET OF THE NORTH HALF
OF THE NORTHEAST QUARTER OFTHE NORTHEAST QUARTER OF THE NORTHWEST QUARTER
OF SEC71ON 15,TOWNSHIP 23 NORTH.RANGE 5 EAST,WM.,IN KING COUNTh’,WASHINGTON.
DESCRtBED AS FOLLOWS:
COMMENCING AT THE NORTHEAST CORNER OF THE NORTHEAST QUARTER OF THE
NORTHEAST QUARTER OF THE NORTHWEST QUARTER OF SAID SECTION 15;
THENCE SOUTH 003140 WEST.ALONG THE EAST UNE OF SAID SUBDMSION FOR A
DISTANCE OF 42.01 FEET TO A POINT 4200 FEET SOUTH OF THE NORTH LINE OF SAID
SUBDIVISION AND THE POINT OF BEGINNING;
ThENCE CONTINUING SOUTH 0031’40 WEST.1.50 FEET TO A POINT ON THE SOUTH LINE OF
THE NORTH 43.50 FEET OF SAID SUBDIVISION:
THENCE NORTH 8025 WEST PARALLEL WITH THE NORTH LINE OF SAID SUBDIVISION FOR A
DISTANCE OF 230.07 FEET TO ThE WEST LINE OF THE EAST230.00 FEET OF SAID SUBDIVISION;
THENCE NORTH D03V4D EAST.ALONG SAID WEST LINE FOR A DISTANCE OF 1.50 FEET TO
THE SOUTH LINE OF ThE NORTH 4200 FEET OF SAID SUBDIVISION;
THENCE SOUTH BW02’5 EAST.ALONG SAID SOUTH LINE FOR A DISTANCE OF 230.07 FEET TO
THE POINT OF BEGINNING.I
/DEED0fDEDICATION.doc\SMT Page 3 of 4 FORM 04 0001/bh
EXHIBIT MAP
N03 1
1
LN,NWJ /Ec 15-T23N-R5E
SE 128Th ST.
S8802’5g”E 230.07’
SY31 ‘4OW..
42.01’P.O.B.
-j
N8802’5g”w 230.07’—-
.5’RIGHT—OF—WAY DEDICATION S031 ‘40”W
1.50’
APN 152305—9002 I
I
___
1-60’1Z
U,
(3U)C’,
-J
FU)
I
NORTH LN,SOUTH HALF,NE1/4,NE1/4,
_[NWJ/4 SEC.15—T23N—R5E
PTN.NE/4,NW/4,SEC.15—T23N—R5E,W.M.
U)-J-J=
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SCALE:For:JOB NUMBER
HORIZONTAL 1”=60’VERTICAL N/A STORAGE ONE 12740
c3lA &18215 72ND AVENUE SOUTH
‘KENT,WA 98032 ON 4TH 12740L.0O5.doc(425)251—6222
(425)251—8782 FAX Title:SHEET
CIVIL ENGINEERING,LAND RIGHT—OF—WAY
PLANNING,SURVEYING,
G NGI ENVIRONMENTAL SERVICES DEDICATION iof 1
.bRAWN OBH I IAPPROVED OBH IDATE 9/22/2016
Return Address:
City Clerk’s Office
City of Renton
1055 South Grady Way
Renton,WA 98057
BILL Of SALE
Please tizake no mark in the ?nwgin space -Reservedfor County Auditor’s Use Only
TYPE OF DOCUMENT:Bill of Sale
GRANTOR(S):-Uiisn o11Etoran.‘-‘-z V’-4vi.fl U_C.
Additional Project Owner
GRANTEE:City of Renton,a Municipal Corporation
E 230 FT OF THE N 1/2 OF THE NE 1/4 OF THE NE 1/4 OF THE NW
1/4,S15,T23N,R5E,WM,EXCEPT N 42 fT FOR SE 128TH STREET.E
330 FT OF THE N 1/2 OF THE NE 1/4 OF THE NE 1/4 OF THE NW 1/4ABBREVIATEDLEGALOFS15,T23N,R5E,WM EXCEPT THE EAST 230 FT AND THE N t90
DESCRIPTION:FT.
ASSESSOR TAX PARCEL I.D.NUIvifiERS:1523059002,1523059178
NAME OF PROJECT:Storage One on 4th Expansion
ADDRESS OF PROJECT:4815 NE 4th Street
PROJECT FILE N1JMBERS:LUAI 4-001641 ,U1 5008468,PLR-3 896
LEGAL DESCRIPTION:See Attached Exhibit A of this Document
PERSONAL PROPERTY DESCRIPTION:See Attached Exhibit B of this Document
Reference Number(s)of Documents assigned or released:
Additional reference #‘s on page
_____
of document
The Grantor,as named above,for,and in consideration of mutual benefits,hereby grants,bargains,sells and
delivers to the Grantee,as named above,the following described personal property as described in Exhibit B
of this document.
By this conveyance,Grantor will warrant and defend the sale hereby made unto the Grantee against all and
every person or persons,whomsoever,lawfully claiming or to claim the same.This conveyance shall bind
the heirs,executors,administrators and assigns forever.
WITNESS WHE F,said ror(s)has caused this instrument to be executed this 2__day of
By By________
Its___________________Its_____________________
Notary Seal must be within box
BILL OF SALE
Page 2
Project File Number:LUAI4-00164 1,U 15008468,PLR-3$96
)SS
Notary Public in and for the State ofWashington
Notary (Print):
_____________________________
My appointment expires:
___________________
Dated:
Notary Seal must be within box
4.
4
Go ‘..%-_
a%’,
t.),
0•,•,•—
“S
REPRESENTATIVE FORM Of ACKNOWLEDGEMENT
STATE OF WASHINGTON )SS
COUNTY OF KING
I cert’that I know or have satisfactory evidence that
______________________
I<c.1rvsiv’4 C’3çrcer’signed this instrument,on
oath stated thatshe/they \were authorized to execute the instrument
and acknowledge it as the
________________________________
andie-4€--of tA LLCto be free and
voluntary act of such party/parties for the uses and purposes mentioned in the
instrument.
Notary Public in and for the State of Washington
Notary (Print):LOA..ACLf’.V”C.iLc s}-ct’-—-m.
My appointment expires:C)——20 iDated:(2-Z-—
Notary Seal must be within box
CORPORATE FORM OfA CKNOWLEDGEMENT
STATE Of WASHINGTON )SS
COUNTY OF KING
On this day of_____________,20 ,before me personally appeared
________________________________________________
to me known
to be
________________________________________
of the corporation that
executed the within instrument,and acknowledge the said instrument to be the free
and voluntary act and deed ofsaid corporation,for the uses and purposes therm
mentioned,and each on oath stated that he/she was authorized to execute said
instrument and that the seal affixed is the corporate seal of said corporation.
Notary Public in and for the State ofWashington
Notary (Print):
My appointment expires:
_____________________________________________
Dated:
INDIVIDUAL FORM OF ACKNOWLEDGEMENT
STATE Of WASHINGTON
COUNTY OF KING
I certify that I know or have satisfactory evidence that
_____________________________________________
signed this instrument and
acknowledged it to be his/her/their free and volumtary act for the uses and purposes
mentioned in this instrument.
EXHIBIT A
(LEGAL DESCRIPTION)
THE EAST 230 FEET OF THE NORTH HALF OF THE NORTHEAST QUARTER OF THE NORTHEAST
QUARTER OF THE NORTHWEST QUARTER OF SECTION 15,TOWNSHIP 23 NORTH,RANGE 5
EAST,W.M.,IN KING COUNTY,WASHINGTON,
EXCEPT THE NORTH 42 FEET THEREOF CONVEYED TO KING COUNTY FOR S.E.128TH STREET
BY DEED RECORDED UNDER REECORDING NUMBER 5849731.
Project Name:Urban Self Storage,Inc.
September 22,2016
OBH
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(City Staff Use Only)
Return Address:
City Clerk’s Office
City of Renton
1055 South Grady Way
Renton,WA 98057
City Project Numbers:
WTR -3896
WWP-3896
SWP-3896
TRO -3896
TED-3896
EXHIBIT “B”
Contributary Assets
PROJECT NAME:
CONSTRUCTION PERMIT NO.
PROJECT FILE NUMBER:
Storage One on 4th Expansion
Ui 5008468
LUA14-001641
Per the request of the City of Renton the following information is furnished concerning final costs for
improvements installed and turned over to the City for the referenced project.
ROADWAY,STREET LIGHTS AND SIGNALS
DESCRIPTION QTY UNIT TOTAL COST
Curb and Gutter 260 L.F.$3,835.00
Sidewalk 1322 S.Y.$52,219.00
Asphalt Concrete Pavement 0 S.Y.$-
Monument Case and Cover 0 EA.$-
Traffic Signs -Complete System 0 L.S.$-
Number of Luminaires and Poles 2 EA.$16,000.00
Subtotal $72,054.00
Sales Tax $6,845.13
Grand Total Roadway,Street Lights and Signals $78,899.13
STORMWATER SYSTEM IMPROVEMENTS
QTY UNIT SIZE TYPE DESCRIPTION TOTAL COST
1 EA.48”TYPE 1 Catch Basin $1,500.00
Subtotal $1,500.00
Sales Tax $142.50
Grand Total Stormwater System Improvements $1,642.50
WATER SYSTEM IMPROVEMENTS
QTY UNIT SIZE TYPE ITEM TOTAL COST
644 EA.6”DI Water Main Pipe and Fittings $51,520.00
2 EA.10”Gate Valve Assembly $2,000.00
6 EA.12”Gate Valve Assembly $7,200.00
2 EA.6”Fire Hydrant Assembly $8,000.00
1 EA.Permanent Blow-Off Assembly S 1,800.00
Subtotal $70,520.00
Sales Tax $6,699.40
Grand Total Water System Improvements $77,219.40
Page 1 of I
Denis Law CITY OF--—-Renton
Community &Economic Development Department
C.E.Chip”Vincent,Administrator
AUTHORIZATION OF SPECIAL BILLING
Date:September 07,2016
Address:4815 NE 4TH ST.RENTON,WA 98059-4820
Description:UTILITY CONSTRUCTION FOR NEW STORAGE ONE BUILDING WITH SELF STORAGE,
OFFICE AND RETAIL SPACE.WATER,SEWER,STORMWATER,FRONTAGE
IMPROVEMENTS,&STREET LIGHTING.DRWG U 3896.
Permit:UI 5008468,ENG -Engineering -Construction
Project:PR16-000050
It is the intent of this letter to authorize the City of Renton to bill the undersigned for all costs incurred
relative to the referenced project,by the City of Renton for the following work:
•TIME AND MATERIALS FOR ANY AND ALL ROAD CLEANUP EFFORTS PERFORMED BY CITY
FORCES OR CITY CONTRACT.
•ALL OVERTIME FOR INSPECTION AND RELATED ACTIVITIES,BILLABLE AT A RATE OF SEVENTY
FIVE DOLLARS ($75.00)AN HOUR.
•TIME AND MATERIAL FOR ANY WORK DONE BY CITY STAFF TO REPAIR DAMAGES.
•TIME AND MATERIAL COSTS INCURRED FOR SECONDARY,INDEPENDENT ENGINEERING
REVIEWS,CONSULTATION AND ON-SITE INSPECTIONS AS DEEMED NECESSARY BY THE CITY.
BILLING TO BE SENTTO:(Please Print)
Name:vO.l1Y C 5 (/fl (frbc O 4 Cjv’s”t,LLC.
Company:11 LLC
Address:Souk-v--ku”‘OOO
Phone:-
Fax:o6-32tc3 3711
O4ner/De(,eloPer or Aut rized Agent Date
trNrrF.DSTATES FIRE INSURANCE COMPANY -Bond a’61_5t892O9
1490 Weo:heirner Rd.Sww 300 (77U7)
P0.Cos 2807 •I ouion,Tews 77252-tI07 SPECIAL POtS ER Of ATTOR?’EY
7L’9s4-8353•800.38’19I4 F,kX
Kno All Men By These Presents:
Chat linfted States Fire Insurance Company.hereinafter re1rred to us the Company.in pursuance otautbority grunted by Resolution adopted by the
Board oiDiretors.does hereby nominate,constitute and appoint Thomas Cochcrane and Brian Camev.its true and lawful agent and Attorney-In-fact
to make,execute,seat and deliver,for and on its behalfand as its act and deed,as surety.bonds and contracts ofsuretyship to be given to all obtigees
provided that no bond or contract of suretyship executed under this authority shall exceed the sum of:
One llundrcd Thousand [)ollars (S 100,000.00)
Certificate ofResolution:
This power otattomey is granted and is signed and sealed by fijesitnile under and by the authority of the fbltowing By-laws adopted by the Hoard of
Directors of the Company by an unanimous written consent dated as of the 1 Qe day of December 2003.
Except as the Board olDirectors may authorize by resolution,the Chairman at’the Board,President,any Vice-President,any Assistant Vice President,
the Secretary,or any Assistant Secretary shall have power on behalfoIthe Corporation;(a)to execute.alTix the corporate seal manually or by
facsimile to,acknowledge.vcriIy and deliver any contracts.obligations,insirumetits and documents whatsoever in coimection with its bus mess
including,without limiting the Ibregoing,any bonds,guarantees,undertakings.recognizances.powers ul’attomey or revocations ofany powers or
attorney,stipulations,policies of insurance,deeds,leases,mortgages,releases,satisfactions and agency agreements;(b)to appoint,in writing,one or
more persons tot any or all ofthe purposes mentioned in the pruceding paragraph (a),including affixing the seal otthe Corporation.
In Witness Whereoithe Company has caused itofficiul seat to be hereunto affixed,and these presenis to be signed by its Assistant Vice
President and attested by its Assistant Secretary this 19th day otFchruary.2016
iji
ATTEST:By;
STATE OF TEXAS,
COUNIVOI HARRIS
Un this 19th day ol February,2016.betore me personally came Michael I’.Ziemer to mc known,who being by mc duly sworn,did depose and say;
hat he resides in Cypress,in the County ot’Harris.State ofTexas;that he is Vice President of United States Fire Insurunce Company.the zwporation
lescribed in and which executed the above instrument:that he knows the seal ot’the said corporation,that the seal allixcd to the said instrument is
such corporate seal;that it was so affixed by order otthe Board ofDirectors ofsaid corporation and that he signed his name thereto Its like order,and
in Ida capacity as Vice President.
iIioyPc.Stain 01 tno IIIi_•&i J MyC0ntiiiEgtIes ,4
[‘JUM 04.2019
CownyotHurnu,Sonorre’cus
Mv Conumsvou Co June 04.2019
I,the undersigned,an Assistant Secretary of United States [‘ire lnstirance Conipany.DO HEREBY CERTiFY that the foregoing and anached Poter
olAnorney remains in full force and has not been revoked,and furthermore that the Resolution ofthe Board of’Directors,set forth in the said Power
of Attorney.is now in Force.
Signed and sealed this,,,day otf_.2Olb
:‘K,i 4c.’(
U-4708US (Rev.8/12)
IC DEVELOPMENT -RentonO
PERMIT BOND
Bond Number:615969209 Project Name:Storage Unit Facility Expansion
and United States Fire Insurance Company a Corporation,as Surety,are held and
firmly bound unto the City of Renton,a municipal corporation of the State of Washington,in
the sum of $Five Hundred Thousand-T Hundred Fifty One Dollars and 30/10 (OO25130)lawful money
of the United States of America,for the payment of which,will and truly to be made,we firmly
bind ourselves,and each of our heirs,executors,administrators and assigns,jointly and
severally by these present.
THE CONDITION OF THE FOREGOING OBLIGATIONS IS SUCH,that WHEREAS,the above named
Principal has applied for a permit,pursuant to the provisions of Ordinance No.3205,to do
certain work on a City of Renton roadway,street,alley,avenue,or other public place,during a
period ending 12/212018
NOW THEREFORE,if the above named Principal shall indemnify and save harmless the City of
Renton,from all claims,actions or damages of every kind and description,which may accrue as
a result of opening and/or working upon a roadway,street,alley,avenue,public easement,or
other public place,by him or those in his employ,in installing or making connections with any
public or private sewer or water system,or any other purpose or object whatever,and that he
will replace and restore such roadway,street,avenue,alley or other public place to as good a
state or condition as at the time of the commencement of said work,and maintain the same in
good order to the decided satisfaction of the City of Renton,and that he will comply with all
provisions of his or their franchise of our permit and all resolutions or instruments relating
thereto,this obligation to be void;otherwise to remain in full force and effect.
The liability under this bond is for a period of one year from 12102/2016
to 1210212017 and may be extended by the surety issuing a Continuation
Certificate.
KNOW ALL MEN BY THE5E PRESENT;that we Renton Mini II LLC
of as Principal,
‘s 5ignatur
2016
4815 NE 4th St
Applicant’s Address
Renton,WA,98059
City,State,Zip
t
Attacl1 Power of Attorn,gJ6rm to Bond
lncludcontact ipfrrnt1on.
C)
H:\CED\Data\Form-Tempites\SeIf-Heip Handouts\Public WQrks\FERMIT BOND.dcc Rev:04/2015
DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT —Renton 0
PERMIT BOND
Bond Number:615989209 Project Name:StOrage One 4th UtilIty Construction Permit U15008468
KNOW ALL MEN BY THESE PRESENT;that we Renton Mini II LLC
of
and United States Fire Insurance Company
_____________________________
as Principal,
a Corporation,as Surety,are held and
firmly bound unto the City of Renton,a municipal corporation of the State of Washington,in
the sum of $FiVe Hundred Thousand-Two Hundred FiftyOne Dotars and 301100 ($5QO251 3D)lawful money
of the United States of America,forthe paymentof which,will and trulyto be made,we firmly
bind ourselves,and each of our heirs,executors,administrators and assigns,jointly and
severally by these present,
THE CONDITION OF THE FOREGOING OBLIGATIONS IS SUCH,that WHEREAS,the above named
Principal has applied for a permit,pursuant to the provisions of Ordinance No.3205,to do
certain work on a City of Renton roadway,street,alley,avenue,or other public place,during a
period ending 121212018
NOW THEREFORE,if the above named Principal shall indemnify and save harmless the City of
Renton,from all claims,actions or damages of every kind and description,which may accrue as
a result of opening and/or working upon a roadway,street,alley,avenue,public easement,or
other public place,by him or those in his employ,In installing or making connections with any
public or private sewer or water system,or any other purpose or object whatever,and that he
will replace and restore such roadway,street,avenue,alley or other public place to as good a
state or condition as at the time of the commencement of said work,and maintain the same in
good order to the decided satisfaction of the City of Renton,and that he will comply with all
provisions of his or their franchise of our permit and all resolutions or instruments relating
thereto,this obligation to be void;otherwise to remain in full force and effect.
City,State,Zip
2016
Attch Power of AtdfrieV Form to Bond
lnclçde ccntaWrØa.
<aled with our
The liability under this bond is for a period of one year from 12/02/2016
to 1210212017 and maybe extended by the surety issuing a Continuation
Certificate.
4licafit’s’inatu(
4815 N 4th St
Applicant’s Address
Renton,WA,98059
H:\CED\Data\Form5-Temp lats\5el1-Help Hndout5\PubIic Work\PERMIT BOND,docx Rev;04/2015