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Instrument Number: 20170816000235 Document:BS Rec: $77.00 Page-1
Record Date:8/16/2017 10:11 AM
Return Address:
City Clerk's Office
City of Renton
1055 South Grady Way
Renton, WA 98057
11�11�111uNY'IR'tlIMItl�IIIB
20170816000235
BILL OF SALE Rec: $77.00
KING COUNTY. WA
BILL OF SALE
Please nrake no mark in the nrargin space - Reserrer{%ar Coun(v Andilor's Use Only
TYPE OF DOCUMENT: Bill of Sale
GRANTOR(S): HOTEL AT SOUTHPORT LLC
GRANTEE: City of Renton, a Municipal Corporation
ABBREVIATED LEGAL "NEW LOT A" CITY OF RENTON LOT LINE ADJUSTMENTNO LUA14
DESCRIPTION: 001514 RECORDING NO 20141223900010
ASSESSOR TAX PARCEL I.D. NUMBERS: 0523059075
NAME OF PROJECT: The Hotel at Southport
ADDRESS OF PROJECT: 1053 Lake Washington Blvd. N
PROJECT FILE NUMBERS: LUA 14000645, U 14005809 14006572 , PLR-3772 3816
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 ofdocumeni
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.
IN WETNESS WHEREOF, said Grantor(s) has caused this instrument to be executed this
I id 20
By By
Its CE 0 0 SE CD Dew e fopw-arct Its
day of
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Instrument Number: 20170816000235 Document:BS Rec: $77.00 Page-2 of
BILL OF SALE
Page 2
Project File Number: L(JA14000645, 1114005809 14006572 , PLR-3772 3816
Notary Seal must be within box STATF OF WASHINGTON ) SS
COUNTY OF KING )
[ 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.
Notary Public in and for the State of Washington
Notary (Print):
My appointment expires:
Dated:
REPRESENTATIVE FORM OFACKNOWLEDGEMENT
Notary Seal`rkt�%j`tNp box STATE OF WASHINGTON ) SS
��GO`L�NS1�����/ COUNTY OF KING )
new„ccMt // l certify that I know have sati factu y evidence that
46"=I41� /f G Yl.a , r♦? S signed this instrument, on
S yQ= 0A �j 0, oth stated that a he/they Qa'/were authorized to execute the instrument
J s, s t— Od acknowledge it as the G0 D�SrCOOLt � LG
$ �v of Q D1A o e free and
y . 01 a SZoluntary aAf such party/parties for the uses and purposes mentioned in the
��jl ST tyt q 4b inst�rument.
r►rl T a OF '11$1
0 L +w �- X.
ru
Notary Public in and fort State of Washington
Notary (Print): Q-44U I✓I S
My appointment expires: 11-24-1
Dated: '7 — /1—/ 7
CORPORATE FORM OFACKNOWLEDGEMENT
Notary Seal must be within box 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 of said corporation, for the uses and purposes therin
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 of Washington
Notary (Print):
My appointment expires:
Dated:
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Instrument Number: 20170816000235 Document:BS Rec: $77.00 Page-3 of
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Instrument Number: 20170816000235 Document:BS Rec: $77.00 Page-4 of
Return Address:
City Clerk's Office
City of Renton
1055 South Grady Way
Renton, WA 98057
PROJECT NAME:
CONSTRUCTION PERMIT NO. (U)
PROJECT FILE NUMBER:
EXHIBIT "B"
Contributary Assets
The Hotel at Southport
1400580914006572
14000645
(Cite Starr Use only
City Project Numbers:
WTR - 3772 3816
W WP - 3772 3816
SWP- 37723816
TRO - N/A
TED - N/A
Per the request of the City of Renton the following information is famished concerning final costs for
improvements installed and turned over to the City for the referenced project.
WATER SYSTEM IMPROVEMENTS
CITY
UNIT
SIZE
TYPE ITEM
TOTAL COST
33
L.F.
4"
DI Water Main Pipe and Fittings
$ 1,650.00
57
L.F.
6"
DI Water Main Pipe and Fittings
$ 3,192.00
1630
L.F.
12"
DI Water Main Pipe and Fittings
$ 130,400.00
1
EA.
4"
Gate Valve Assembly
$ 500.00
7
EA.
6"
Gate Valve Assembly
$ 4,900.00
2
EA.
8"
Gate Valve Assembly
$ 1,600.00
18
EA.
12"
Gate Valve Assembly
$ 21,600,00
6
EA.
6"
Fire Hydrant Assembly
$ 24,000.00
1
EA.
4"
Large Water Meter Assembly
$ 9,000.00
^
Subtotal
$ 196,842.00
Sales Tax
$ 18,699.99
Grand Total Water System Improvements
$ 215,541.99
SANITARY SEWER SYSTEM IMPROVEMENTS
CITY UNIT SIZE TYPE DESCRIPTION TOTAL COST
I EA. 48" Diameter Manhole $ 6,000.00
Subtotal $ 6,000.00
Sales Tax $ 570.00
Grand Total Sanitary Sewer System Improvements $ 6,570.00
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