HomeMy WebLinkAboutRizak Shay - Permit Agreement for Permits B17-1930, B17-1931, B17-1934, B17-1935 at 4407 Segovia Drive (1884544)FRANKLIN COUNTY RECORDING
COVER SHEET
NAME AND RETURN ADDRESS:
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AFN # 1884544 AGREE
0911412018 101.00 M
3 Pages) $ Auditor
Matt Beaton,
Franklin C0-- WA
FORM COMPLETED BY: 1i c s S PHONE # C5os�5y5- 3zlsil
PLEASE PRINT OR TYPE INFO ATION:
DOCUMENT TITLE(S) (or transaction contained therein)
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GRANTOR(S) (Last name, first name, middle name/initials):
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GRANTEE(S) (Last name, first name, middle name/initials):
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LEGAL DESCRIPTION (Abbreviated: ie.lot, block, plat or section, township, range)
Aese��k Swnsa� O.v. L mar! ZSR Lo -r L15., Le+'4L{ ) Lot 29
Additional legal is on page of document
AUDITOR'S REFERENCE NUMBER(S)
ASSESSOR'S PROPERTY TAX PARCEL NUMBER
14'10\\8�) k\b,4kA0IS5)1\ %10 -�-Ao1J 114kvtiLao t-kck
0 Additional parcel numbers on page of document
The Auditor/Recor,ler will rely on the information provided on this form. The staff will not read the
document to verify the accuracy or completeness of the indexing information
EMERGENCY NONSTANDARD REQUEST
am requesting an emergency nonstandard recording for an additional fee of $50.00 as provided in
RCW 36.18.010. 1 understand that the recording processing requirements may cover up or otherwise
obscure some part of the text of the original document.
Signature Date
After Recording, Return To:
City of Pasco, Washington
Attn: City Planner
525 North 3rd Ave
Pasco, WA 99301
Permit Agreement
Permit #s B17-1930, B17-1931, B17-1934, and B17-1935
I, Rizak Shay, hereby acknowledge and understand I have applied for building permits to
convert four garages into bedrooms at 4407 Segovia Drive, 4411 Segovia Drive, 4412 Artesia
Drive, and 4408 Artesia Drive (Parcel #s 116440118, 116440135, 116440134, and 116440119)
for the purposes of establishing sleeping quarters for the care -givers employed at From the Heart
which is considered an adult family home.
I also acknowledge that according to RCW 70.128.010, "adult family home means a
residential home in which a person or persons provide personal care, special care, room, and
board to more than one but not more than six adults who are not related by blood or marriage to
the person or persons providing the services." As such, I understand that the new living spaces
created as a result of the garage conversions shall only be used as sleeping quarters for care-
givers and not as bedrooms for additional residents.
With the aforementioned acknowledged I, Rizak Shay, am requesting approval of the
four building permits to enable work on my buildings on Segovia Drive and Artesia Drive.
DATED this r !y day of September, 2017.
Rizak Shay
STATE OF WASHINGTON ) ss:
County of Franklin )
Rizak Shay Permit Agreement
On this 1 7 13day of , 2017, before me personally appeared Rizak
Shay, to me known to be the individual who executed the foregoing instrument and
acknowledged he signed the same as his free and voluntary act and deed, for the uses and
purposes therein mentioned.
GIVEN under my hand and official seal the day and year first written above.
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NOTARY PUBLIC in and fo St e of Washington
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Rizak Shay Permit Agreement