HomeMy WebLinkAboutBond Monitoring - PLN General - 10/13/2005 R C�
IVY
MASON COUNTY BOND FORMM OCT 73 2 D
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Type of Permit: �q�p-yi�+ -
Name: 6V AUK ik (J Alf)L_t 6 HJU c
Type of Improvement: AD p,T1&
Project Location: R{( 6- cdq'rr-(ZtAJR-EEL PtACL (,t n (Lv LJA �lgSCfZ
Legal Description of Property: -* E, q q.4 1 ' 6 F Ttt; w. Z gx�-• t 2' D Cc 0%h tO i 3
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With reference to the above-identified matter, this will certify that this institution has a
savings account(or loan) for the above-referenced owner/developer/contractor for the
project so identified. In consideration of the permitted improvement, and in lieu of a
performance bond, this institution hereby agrees that it will freeze the following sums of
money for the indicated improvement pending written authorization for release of said
funds by in the amount of Dollars.
The total sum indicated will be withheld by this institution from any disbursements of
any kind until written authorization has been received by this institution from Mason
County to release the sum of money indicated by the written authorization from the
County.
The design, location;materials and other specifications for the indicated improvement are
those required by Mason County as appears in the above-referenced document/permit,
and shall be in compliance with the Mason County Resource Ordinance, Chapter 8.52
Mason County Code as amended.
These funds shall be held by the institution for a period of three years. In the event that
aWHLLtS I li ALL1Z-►L� 6S(responsible party's name) does not comply with the
aforementioned requirements, Mason County may demand, and the institution shall
make, payment to Mason County of said funds so that the necessary repairs can be
performed immediately to Mason County standards. The institution shall not be liable to
Ct+ LE5 ��21� [+�4�responsible party's name) for any disbursement of
said funds to Njason County. The conditions in this agreement may only be amended or
revoked by a press written condition of Mason County.
/O •13-OS
61,
2o�S
Signature o Responsible Party Date
Confidential Page I Form Revised: 03/25/03
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Name of Bank/Phone Rumber
Luc, fills ►UO I
Approved: ' \c•, b\�K c,
Title: r--. -'- ►v�A
Bank Address
Date
• 1az� l� ) C� -
Account Number
STATE OF WASHINGTON,
County of 'Pr-Nti��j (Individual Acknowledgement)
I, Y, S-�w Notary Public in and for the State of
Washington,residing at E do hereby certify that
on this )3 day of Oc. 20 0 ,personally appeared
before me L1\,t en � ��.lrn �1,�50� ,to me known to be the individual
described herein and who executed this instrument and acknowledged that Ike
signed and sealed the same as 1\ free and voluntary act and deed for the uses
and purposes herein mentioned
GIVEN UNDER MY HAND AND OFFI this day of
20 yS
`,���•0��1►��E �' +'rl���i,��� otary Public in an for the State of
Washington,residing at
in said
County. My Commission expires
Obi�w As�;�����`
Confidential Page 2 Form Revised:03/25/03