HomeMy WebLinkAboutBond Form - PLN General - 1/10/2006 RECEIVED
FEB 0 7 2006 1
MASON COUNTY BOND FORM MCCD - PLANNING
Type of Permit: k rW6.n,1 V"l y,.-1 ,CMG W E—.sv T" leo 3 —Cc 23 3
Name: �-GC�(ce— L t e -,en u C.. �c__&
Type of Improvement: &-cer4r,6'&v\
Project Location: L—C+ (3 D 4 ,
Legal Description of Property:
rJa,se"s ( ` V, I Q 5 1 rMSA"'. Cou w po 3 2. L 7 S 3 ao 13S
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$ '14pcO 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.
e funf s shall be eld by the institution for a period of three years. In the event that
".�" .ike-- (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
(responsible party's name) for any disbursement of
said funds to Mason County. The conditions in this agreement may only be amended or
revoked by express written condition of Mason County.
3t
Signature of Responsible Party ate
J ,
Confidential Page I Form Revised: 03/25/03
Y3-�,7A C,3 Accepted:
Nam of Bank/Phone Number
Approved:
-17110
Bank Address
Date
y7/a7 �- o
Account Number
STATE OF WASHINGTON,
County of !��� (Individual Acknowledgement)
I, UG�-QrL a Notary Public in and for the State of
Washington,residing at , do hereby certify that
on this v v day 4A 20 GS" , personally appeared
before me to me known to be the individual
described herein and who executed this instrument and acknowledged that V�
signed and sealed the same as free and voluntary act and deed for the uses
and purposes herein mentioned.
GIVEN UNDER lADD.OFFICIAL SEAL this_��day of
•off NOTgRy '�•,
��. ��°U6LIC :O Notary Public in an for a State of
'.�'F •:�� s, 2z°6• G� Whin ;residing at
�P,,�yq g1N\����`� D cle in said
d County. M Commission expires
Confidential Page 2 Form Revised: 03/25/03