HomeMy WebLinkAboutRecording and Statement of Intent (lot certification) - writableAFTER RECORDING MAIL TO:
Name: Jefferson County DCD, DRD___
Address: 621 Sheridan________________
City/State: Port Townsend, WA 98368____
All Situate in the County of Jefferson, State of Washington
Lot Certification
MLA Number:________________________________
Parcel Number: _______________________________
Section________ Township _______ Range _______
Grantor(s):
1.
Grantee(s):
1.
Legal Description: Parcel involved in the lot certification are currently legally described
as follows (include Assessor’s Property Tax Parcel Account Number):
Parcel A:
Parcel B:
Lot certification described as follows (new legal description in metes and bounds):
Revised Parcel A:
Revised Parcel B:
This lot certification exemption complies with Jefferson County Code (JCC section 18.35.040(1) or (4)
Jefferson County Consistency:
This lot certification is compliant with Jefferson County Code 18.35.040(1) or (4) for the
purpose of assisting with the segregation of land into lots, tracts or parcels. Each one of
which is one-sixteenth of a section of land or larger or segregated by a public road right-
of-way or an existing legal lot of record.
(Proponents’ signature)
STATE OF WASHINGTON
COUNTY OF
On , 20___, personally
appeared and proved to me on the
basis of satisfactory evidence to the person whose name is subscribed to this instrument,
and acknowledged that he executed it.
WITNESS my hand and official seal this _____ day of
, 20___ .
Notary Public in and for the State of Washington,
Residing at
This Lot Certification has been reviewed and approved by the
Jefferson County Treasurer Office and taxes have been paid in full for the year.
________________________________
Treasurer Office
This Lot Certification has been reviewed and approved by the
Jefferson County Development Review Division.
_______
Associate/Assistant Planner Date