HomeMy WebLinkAboutOwner Declaration of AgencyProject Address
Parcel No.
do hereby declare and affirm that I/we are:
❑ the owners or contract purchasers of the above property
❑ an officer or representative of a Washington corporation or trust which is the owner
of the above property. I am duly authorized by this entity to represent the above property in matters of ownership, land use, and
construction. Attached, please find a copy of the Power of Attorney or other document by which I have been appointed.
AGENCY
I/We are applying for one or more permits for development of the above property. I/We understand that the proposed work may also include
additional permits for land use approvals.
For the purposes of applying for the applicable permits and managing the owner's responsibility for compliance with the approved plans and
any land use permits associated with this project, I/we
❑ will act as my own agent
❑ do hereby appoint to act as my agent in dealing with the City of Medina in all
acts and decisions related to processing the application for permit, review and approval of the application, authorization of revisions,
and coordination of required inspections and project approvals.
AGREEMENT TO CONDITIONS
I/We agree as a condition of this permit:
• To comply with all applicable codes, ordinances, laws and conditions of approval in effect at time of permit issue.
• To ensure that all work shall be done in accord with the approved plans and specifications, which shall not be modified without the prior
approval of the Building Official. I/We will provide all data and details of revisions to the approved plans to the City prior to undertaking
any work that differs from the approved plans. The official approved plans for the project shall be those plans that are stamped and
dated as approved by the City of Medina.
• To inform all contractors, subcontractors and workers of these conditions and any project mitigation requirements agreed to, and I/we
will enforce compliance thereto.
• To maintain the approved plans, all correction notices, all inspection reports, and all permit documents on the project site and readily
available to the inspectors.
• To ensure that requests are made to the City for the required inspections. Failure to notify the Development Services Department that
the work is ready for inspection may necessitate the removal of some of the construction materials at the owner's expense in order to
perform required inspections.
• To cause all certifications required by the City to be completed and to reconcile the permit fees upon completion of the work. I/We
understand that the City will not issue a Certificate of Completion or a Certificate of Occupancy until these documents are completed.
• I/We acknowledge that consultant fees may be incurred as a result of the review and inspection of the proposed work. I/We agree to be
responsible for the payment of these fees and understand that the payment of these fees is required prior to issuance of a Certificate of
Occupancy.
SALES TAX
All contractors and vendors must report sales taxes for transactions in the City of Medina on quarterly \combined excise tax returns. The 4-
digit location code for the City of Medina is 1718.
OWNER OR OFFICER/REPRESENTATIVE NAME AND SIGNATURES
I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE REQUIREMENTS.
Signatu
Date
1 of 1 Rev. 01/10/2018