Recorded statement.pdf11111111111111111111111111111111111111111111111111111611111111111
051IW201793;33 m 8g14.00 PGS
SNOHOMISH COUNTY, RRSHINGTON
Return Recorded Instrument To:
City of Edmonds — Clerk's Office
121 5th Avenue North, Edmonds WA 98020
ACCESSORY DWELLING UNIT & FAMILY STATEMENT
Property Address: 8030 238' Street SW, Edmonds Washington
Assessor's Parcel Number: 00451900200302
FRUITLAND ACRES TO LAKE BALLINGER BLK 002 D-02 LOT 3 BLK 2 3
Legal Description: EXC THE N 244FT THOF TGW THE N 20FT OF LOT 20 BLK 2 EXC THE E
g p ' 20FT THOF AKA LOT 4 OF CITY OF ED SP S-62-76 REC AFN 7612140242 &
CORR REC AFN 7704260268
Grantor(s): Herry Sumarti & Paula Darwis Tjoa
Grantee: City of Edmonds
Related Permit Numbers: BLD20170486
I have read the requirements for accessory dwelling units contained in Chapter 20.21 of the Edmonds
Community Development Code (ECDC) and understand that an accessory dwelling unit as defined in
ECDC Section 21.05.015 is prohibited until an Accessory Dwelling Unit Permit is approved.
I understand that an Accessory Dwelling Unit Permit cannot be approved unless all the criteria in
Chapter 20.21 are met, and all the necessary items are submitted, including an affidavit of occupancy and
a covenant to be filed with the Snohomish County regarding the regulations imposed on Accessory
Dwelling Units.
I also understand that without obtaining an Accessory Dwelling Permit, only one family and two
additional renters may live within the residence pursuant to ECDC 21.30.010. The structure cannot be
permitted to be used as a boarding house, as boarding houses are not permitted uses on single family
residential zoned parcels.
OWNER/GRANTOR: Herry Sumarli
SIGNATURE:'
OWNER/GRANTOR: Pa la Darwis Tjoa
SIGNATURE:
DAT : this 10'M day of gj�' 2017
On this day personally appeared before me Herry Sumarli & Paula Darwis Tjoa, to me known to be the
individuals described therein and who executed the within and foregoing instrument, and acknowledged
that they signed the same as their free voluntary act and deed, for the use and purposes therein
mentioned. Notary's pressure seal must be smudged.
Dated: )V"go I?
Signature of Notary Public:
Residing At: �l+bYe�ln�gyt
My Appointment Expires: � r j"1. a[ �'�£
- THIS DOCUMENT MUST BE RECORDED WITH THE SNOHOMISH COUNTY AUDITOR -
WASHINGTON SHORT -FORM INDIVIDUAL ACKNOWLEDGMENT
RCW 42.44.100
State of Washington
ss.
County of
�efyy SuM&rji
I certify that I know or have satisfactory evidence that'g. itF/tS /c
Name of Signer
is the person who appeared before me, and said
person acknowledged that he/she signed this
instrument and acknowledged it to be his/her
free and voluntary act for the uses and purposes
mentioned in the instrument.
Dated: _Aiz/D , 01q
MonthlDay/Year
*-— SHEILA MAY THOMAS Notary Public!
State of Washington Signature 6f No arizing Officer
My Appointment Expires
Dec 19, 2020o r tblic
._......... .._._._._.
._._._._.__._._._.._.._._.. ._._
Title (Such as "Notary Public
Place Notary Seal andlor Stamp Above My appointment expires: he., "
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document
or fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Document Date:
Signer(s) Other Than Named Above:
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02015 National Notary Association - www.NationalNotary.org - 1 -800 -US NOTARY (1-800-876-6827) Item #5906