Washington State Energy Compliance Forms - DOC by nfb18092


Washington State Energy Compliance Forms document sample

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									                                                                                                    Web date: 06/28/2007

                                                                      AFFIDAVIT CONCERNING
                                                                    CRITICAL AREAS COMPLIANCE
Department of Development
and Environmental Services
900 Oakesdale Avenue Southwest
Renton, WA 98057-5212
206-296-6600     TTY 206-296-7217                                 For alternate formats, call 206-296-6600.

STATE OF WASHINGTON                    )
                                       ) SS
COUNTY OF KING                         )

File Number:

Application Name:

Project Location:

The undersigned, being first duly sworn on oath deposes and says:

        1. That the affiant is competent to be a witness herein;

        2. That the affiant is the applicant for the above project;

        3. That to the best of the affiant's knowledge the critical areas on the development proposal
           site have not been illegally altered; and

        4. That the affiant has not previously been found to be in violation of critical areas regulations
           for any property in King County, or alternatively, that if there have been any violations, such
           violations have been/are being resolved to the satisfaction of King County.

Applicant signature                                               Date and Place (City and State)

I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.

                          Check out the DDES Web site at www.kingcounty.gov/permits
d6a2a8f5-3d25-46db-a62b-2ad72dfdbdb6.doc   lc-aff-sacomp.pdf   06/28/2007                                    Page 1 of 1

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