Poulsbo, Washingtonin a BLA , unless they meet the statutory exemption provided under RCW 58.04.007 and WAC 458 -61A -109 . SIGNATURES: I, the undersigned, state that, to the best

BOUNDARY LINE ADJUSTMENT Planning and Economic Development Department

200 NE Moe Street | Poulsbo, Washington 98370

(360) 394-9748 | fax (360) 697-8269

www.cityofpoulsbo.com | plan&[email protected]

A boundary line adjustment may not result in actions requiring the replat, amendment, alteration, or vacation of a

plat or short subdivision, and must be consistent with all applicable zoning, health, building and engineering

regulations. In general, a boundary line adjustment purpose applies to minor boundary changes, correct a controversy

regarding the location of a lot line, remedy property use constraints caused by adverse topographical features,

consolidate previously platted lots into a single or fewer parcels, or other similar circumstances. For additional

information on submittal and review requirements, refer to PMC Chapter 17.30.

PROPERTY OWNERS (attach additional sheets if necessary):

Name: Phone:

Address:

Email:

Name: Phone:

Address:

Email:

AUTHORIZED APPLICANT/PROJECT CONTACT:

Name: Phone:

Address:

Email:

PERSON RESPONSIBLE FOR PAYMENT:

Name: Phone:

Address:

Email:

NAME OF LAND SURVERYOR:

Name: Phone:

Address:

Email:

PROJECT DETAILS:

Description of Proposal:

Concurrent Application(s):

http://www.cityofpoulsbo.com/http://www.codepublishing.com/WA/Poulsbo/#!/Poulsbo17/Poulsbo1730.html

Parcel Owner Assessor’s Parcel # Is Property

Developed?

Sq. Ft. Before

Adjustment

Sq. Ft. After

Adjustment

Yes No

Yes No

Yes No

Parcel Current Use Zoning Designation Critical Areas Shoreline

Designation

APPLICATION SUBMITTAL REQUIREMENTS:

Electronic version of all submitted materials in PDF format (CD, thumb drive, via e-mail).

Application Fees Per Resolution 2017-03. Additional hourly fees may apply.

Notarized property owner and/or applicant signature page (attached).

Title Insurance Report, prepared within last 30 days (available from a Title Company).

Three clean and legible drawings suitable for recording showing the following:

1. A map at a scale of not less than one inch to fifty feet which depicts the existing property configuration, including all lot lines, dimensions and lot area.

2. A map at a scale of not less than one inch to fifty feet which depicts the proposed property configuration, including all lot lines, dimensions and lot area.

3. The location and dimensions of all structures/improvements existing upon the affected lots and the distance between such structures/improvements and the existing and proposed boundary lines.

4. The location and dimensions of any easements within or adjacent to the affected lots.5. The location, dimensions and names of all existing or platted street rights-of-way (public or private)6. The location of all existing and proposed water, sewer and storm drainage facilities, on-site wastewater

disposal systems, drainfields, and wells.

7. The location of access to all affected lots.8. A north arrow and bar scale.

The original legal descriptions of all affected properties, together with new separate legal descriptions for each

parcel resulting from the adjustment.

All drawings and legal descriptions are required to be prepared, stamped and dated by a licensed land surveyor

as set forth in PMC 17.80.080.

A copy of any covenants, conditions and restrictions (CCRs), deed restrictions, concomitant agreements,

easements, or development agreements pertaining to the affected properties.

When two or more property owners are involved in the BLA, a conveyance document (i.e. Quit Claim or Warranty

Deed) that deeds land to an adjoining property owner as part of the BLA is required.

If an existing on-site sewage (septic tank) disposal system and/or well will continue to be used on an affected

property after the boundary line adjustment, and/or if a new on-site sewage disposal system or well is proposed

for an affected property where city code does not require connection to the city’s municipal sewer and/or water

system, the applicant shall provide written verification from the Kitsap Public Health District that the proposed

lot is adequate to accommodate an on-site sewage disposal system and/or well.

Any other information/documents:

NOTE: Taxes must be paid in full for the current tax year, and on all preceding years, on all properties involved

in a BLA, unless they meet the statutory exemption provided under RCW 58.04.007 and WAC 458-61A-109.

https://psearch.kitsapgov.com/webappa/http://www.cityofpoulsbo.com/planning/documents/2015_zoningmap_with_2015CPAs.pdfhttps://cityofpoulsbo.com/codes-amendments-maps/http://www.cityofpoulsbo.com/planning/smp_maps.htmhttp://www.cityofpoulsbo.com/planning/smp_maps.htmhttp://www.cityofpoulsbo.com/planning/documents/2017FeeSchedule.pdfhttp://www.codepublishing.com/WA/Poulsbo/#!/Poulsbo17/Poulsbo1780.html#17.80.080https://app.leg.wa.gov/rcw/default.aspx?cite=58.04.007http://apps.leg.wa.gov/wac/default.aspx?cite=458-61A-109OwnerHighlight

OwnerHighlight

SIGNATURES:

I, the undersigned, state that, to the best of my knowledge, all the information provided in this application is true and complete. It is understood that the City of Poulsbo may nullify any decision made in reliance upon information given on this application form should there be any willful misrepresentation or willful lack of full disclosure on my part.

I hereby authorize City of Poulsbo representative(s) to inspect the subject property Monday-Friday between the hours of 8:00 am and 4:00 pm during this permit application process.

Signature of Applicant/Agent

Print Name of Applicant/Agent

STATE OF WASHINGTON) ) SS

COUNTY OF KITSAP )

On this day of , 20 before me, the undersigned, a Notary Public in and for the State of Washington, duly commissioned and sworn, personally appeared

to me known to be the individual(s) described in and who executed the within and foregoing instrument, and acknowledged that he/she/they signed the same as his/her/their free and voluntary act and deed, for the uses and purposes therein mentioned, and on oath stated that he/she/they was (were) authorized to execute said instrument.

WITNESS my hand and official seal this day of , 20 .

NOTARY PUBLIC in and for the State of Washington Residing at

Commission Expires

The primary applicant needs to fill out and submit this form.

PROPERTY OWNER'S SIGNATURE (if other than applicant/agent):

I, the undersigned, state that, to the best of my knowledge, all the information provided for this application is true and complete. It is understood that the City of Poulsbo may nullify any decision made in reliance upon information given on this application form should there be any willful misrepresentation or willful lack of full disclosure on my part.

Signature of Property Owner

Print Name of Owner

STATE OF WASHINGTON) ) SS

COUNTY OF KITSAP )

On this day of , 20 before me, the undersigned, a Notary Public in and for the State of Washington, duly commissioned and sworn, personally appeared

to me known to be the individual(s) described in and who executed the within and foregoing instrument, and acknowledged that he/she/they signed the same as his/her/their free and voluntary act and deed, for the uses and purposes therein mentioned, and on oath stated that he/she/they was (were) authorized to execute said instrument.

WITNESS my hand and official seal this day of , 20 .

NOTARY PUBLIC in and for the State of Washington Residing at

Commission Expires

Each impacted property owner needs to fill out and submit this form.

748 Winslow Way E.

Bainbridge Island, WA. 98110

PH:(206) 842-4188

FAX:(206) 238-9125

SÁEZ CONSULTING ENGINEERS, INC.

Civil Engineering, Planning, Surveying, Design, & CA

JOB NO. 18011

DRAWN: MKF CHECKED: MRB

DATE: 8/28/2018

50

SCALE OF FEET

5 10

NORTH

COVER AND LEGAL INFORMATION

MIC

HAELR.BOW

EN

PARCEL B

OWNER: CMP INVESTMENT GROUP LLC

ASSESSOR'S ACCOUNT NO.: 102601-2-054-2004

ZONING: CITY

BOUNDARY LINE ADJUSTMENT

SEC.10, T.26N., R.1E., W.M.

CITY OF POULSBO, KITSAP COUNTY, WASHINGTON

SE 1/4 OF THE NW 1/4

SHEET 1 OF 3

AUDITOR'S CERTIFICATE _______________________________________________

FILED FOR RECORD THIS _________ DAY OF _____________, 20____

AT _____________ M, IN BOOK ___________, OF ___________ AT PAGE ___________

AT THE REQUEST OF MICHAEL R. BOWEN.

_____________________________ ___________________________

COUNTY AUDITOR. DEPUTY AUDITOR

THIS MAP CORRECTLY REPRESENTS A SURVEY MADE BY ME OR UNDER

MY DIRECTION IN CONFORMANCE WITH THE REQUIREMENTS OF THE

SURVEY RECORDING ACT AT THE REQUEST OF TONY JACOBELLIS.

_________________________________________

MICHAEL R. BOWEN

CERTIFICATE NUMBER 29294

SURVEYOR'S CERTIFICATE

PARCEL A

OWNER: CMP INVESTMENT GROUP LLC

ASSESSOR'S ACCOUNT NO.: 102601-2-053-2005

ZONING: CITY

10

N

W

F

I

N

N

H

I

L

L

R

D

O

L

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A

V

A

W

A

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A

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5

H

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A

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3

0

5

UR

DA

HL

RD

N

W

NW RELIANCE ST

SUBJE

CT

PROP

ERTY

H

I

G

H

W

A

Y

5

SEC.10, T.26N., R1E.,W.M.

VICINITY MAP

PARCEL A

LOT 5-B, CITY OF POULSBO SHORT PLAT NO. P-105 (COLLEGE MARKETPLACE), RECORDED UNDER

AUDITOR'S FILE NO. 200602090028, IN VOLUME 19 OF SHORT PLATS, PAGES 66-69, THAT PART OF

SECTION 10, TOWNSHIP 26 NORTH, RANGE 1 EAST, W.M.

PARCEL B

LOT 5-C, CITY OF POULSBO SHORT PLAT NO. P-105 (COLLEGE MARKETPLACE), RECORDED

UNDER AUDITOR'S FILE NO. 200602090028, IN VOLUME 19 OF SHORT PLATS, PAGES 66-69, THAT

PART OF SECTION 10, TOWNSHIP 26 NORTH, RANGE 1 EAST, W.M.

LEGAL DESCRIPTIONS FOR ORIGINAL PARCELS

1. THIS SURVEY WAS ACCOMPLISHED BY FIELD TRAVERSE WITH A THREE SECOND TOTAL

STATION.

2. THIS SURVEY CONFORMS TO THE MINIMUM FIELD TRAVERSE STANDARDS FOR LAND

BOUNDARY SURVEYS AS LISTED IN WAC 332-130-090.

3. SUBJECT TO A 10 FOOT WIDE NONEXCLUSIVE EASEMENT TO PUGET SOUND ENERGY,

CENTERED ON FACILITIES CONSTRUCTED OR TO BE CONSTRUCTED, EXTENDED, OR

RELOCATED, RECORDED UNDER RECORDING NO.200308190176.

4. SETBACKS:

MINIMUM FRONT SETBACK: 25 FEET

(RIGHT-OF-WAY TO STRUCTURE)

MINIMUM REAR SETBACKS: 10 FEET

(LOT/BOUNDARY LINE TO STRUCTURE)

MINIMUM SIDE SETBACKS: 10 FEET

(LOT/BOUNDARY LINE TO STRUCTURE)

NOTES

O

LY

M

PIC

C

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G

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W

A

Y

DIRECTOR'S APPROVAL

APPROVED FOR RECORDING PURSUANT TO THE

POULSBO MUNICIPAL CODE CHAPTER 17.22

KARLA BOUGHTON, DIRECTOR

PLANNING AND ECONOMIC DEVELOPMENT

DATE:

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AutoCAD SHX Text29294

748 Winslow Way E.


PH:(206) 842-4188

FAX:(206) 238-9125



JOB NO. 18011


DATE: 8/28/2018

50

SCALE OF FEET

5 10

NORTH

NORTH

20

0 40 80

1"=40'

FEET

EXISTING LOT CONFIGURATION

MIC

HAELR.BOW

EN

ORIGINAL PARCEL AREAS

SHEET 2 OF 3


SEC.10, T.26N., R.1E., W.M.



LOT 5-A

SHORT PLAT

RECORDING NO.

200602090028

LOT 5-B

SHORT PLAT

RECORDING NO.

200602090028

LOT 5-C

SHORT PLAT

RECORDING NO.

200602090028

LEGEND

AutoCAD SHX TextN 88°05'51" W 381.09'

AutoCAD SHX Text22' UTILITY VAULT EASEMENT PER AF# 200601250116

AutoCAD SHX TextSHARED ACCESS EASEMENT PER AF# 200601250115

AutoCAD SHX Text15' SEWER EASEMENT PER AF# 200601250115

AutoCAD SHX Text10' UTILITY EASEMENT PER AF# 200602090029

AutoCAD SHX Text15' STORM AND SANITARY SEWER EASEMENT PER AF# 200602090028




AutoCAD SHX Text30' X 30' SHARED ACCESS EASEMENT PER AF# 200602090028




AutoCAD SHX Text7.5' SANITARY SEWER EASEMENT PER AF# 200602090028

AutoCAD SHX TextUTILITY EASEMENT PER A.F. NO. 200601200110

AutoCAD SHX Text15' WATER LINE EASEMENT PER AF# 20080204002

AutoCAD SHX Text121.82'


AutoCAD SHX TextN 01°54'24" E 422.00'










AutoCAD SHX TextN 88°05'51" W 416.13'

AutoCAD SHX TextNW RELIANCE ST

AutoCAD SHX TextMARKET PL NW


AutoCAD SHX TextFOUND PROP COR "TSWIFT 38489"





AutoCAD SHX TextFOUND MON IN CASE

AutoCAD SHX TextFOUND MON IN CASE

AutoCAD SHX TextORIGINAL PARCEL LINE TO BE ADJUSTED

AutoCAD SHX TextBUILDING



AutoCAD SHX TextLOT 5-B 58,658 SQ.FT. ± (1.35 ACRES)

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748 Winslow Way E.


PH:(206) 842-4188

FAX:(206) 238-9125



JOB NO. 18011


DATE: 8/28/2018

50

SCALE OF FEET

5 10

NORTH

RESULTANT LOT CONFIGURATION

MIC

HAELR.BOW

EN

SHEET 3 OF 3


SEC.10, T.26N., R.1E., W.M.



LOT 5-B

LOT 5-C

RESULTANT PARCEL AREAS

BEGINNING AT THE NORTHEAST CORNER OF LOT 5-C, CITY OF POULSBO SHORT PLAT NO. P-105

(COLLEGE MARKETPLACE), RECORDED UNDER AUDITOR'S FILE NO. 200602090028, IN VOLUME 19 OF

SHORT PLATS, PAGES 66-69, THAT PART OF SECTION 10, TOWNSHIP 26 NORTH, RANGE 1 EAST, W.M.;

168.37 FEET, AN ARC DISTANCE OF 63.95 FEET;


RESULTANT LOT 5-B

RESULTANT LOT 5-C

NORTH

FEET

1"=40'

80400

20

BEGINNING AT THE NORTHEAST CORNER OF LOT 5-C, CITY OF POULSBO SHORT PLAT NO. P-105

(COLLEGE MARKETPLACE), RECORDED UNDER AUDITOR'S FILE NO. 200602090028, IN VOLUME 19 OF

SHORT PLATS, PAGES 66-69, THAT PART OF SECTION 10, TOWNSHIP 26 NORTH, RANGE 1 EAST, W.M.;

OF BEGINNING;

168.37 FEET, AN ARC DISTANCE OF 63.95 FEET,


LOT 5-A

SHORT PLAT

RECORDING NO.

200602090028


AutoCAD SHX Text15' SEWER EASEMENT PER AF# 200601250115

AutoCAD SHX Text15' STORM AND SANITARY SEWER EASEMENT PER AF# 200602090028





AutoCAD SHX Text7.5' SANITARY SEWER EASEMENT PER AF# 200602090028

AutoCAD SHX TextUTILITY EASEMENT PER A.F. NO. 200601200110

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AutoCAD SHX TextLOT 5-B 65,718 SQ.FT. ± (1.51 ACRES)

AutoCAD SHX TextLOT 5-C 51,597 SQ.FT. ± (1.18 ACRES)



AutoCAD SHX TextRESULTANT PARCEL LINE

AutoCAD SHX Text20' STORM AND SEWER EASEMENT

DOC082918BoundaryLineAdjustmentv3-final18-0828 Jacobellis BLA1Sheets and ViewsCover

2Sheets and ViewsExisting

3Sheets and ViewsProposed

Name: CMP Investment Group, LLC - Ed KimPhone: 206 441-5155Address: 3926 Aurora Ave N Seattle, WA 98103Email: [email protected]_2: Phone_2: Address_2: Email_2: Name_3: Tony JacobellisPhone_3: 206 228-5560Address_3: 7680 NE Hidden Cove Rd Bainbridge Island, WA 98110Email_3: [email protected]_4: Tony JacobellisPhone_4: Address_4: Email_4: Name_5: SCE Consulting Engineers, Inc. - Jaime SaezPhone_5: 206 842-4188Address_5: 748 Winslow Way E. Bainbridge Island, WA 98110Email_5: [email protected] of Proposal: Boundary Line adjustment of Lots 5B and 5C Concurrent Applications: Parcel OwnerRow1: CMPAssessors Parcel Row1: 5B 102601-2-053-2005Sq Ft Before AdjustmentNo: 58,658Sq Ft After AdjustmentNo: 65,718Parcel OwnerRow2: CMPAssessors Parcel Row2: 5C 102601-2-054-2004Sq Ft Before AdjustmentNo_2: 58,658Sq Ft After AdjustmentNo_2: 51,597Parcel OwnerRow3: Assessors Parcel Row3: Sq Ft Before AdjustmentNo_3: Sq Ft After AdjustmentNo_3: ParcelRow1: Current UseRow1: Zoning DesignationRow1: Critical AreasRow1: Shoreline DesignationRow1: ParcelRow2: Current UseRow2: Zoning DesignationRow2: Critical AreasRow2: Shoreline DesignationRow2: ParcelRow3: Current UseRow3: Zoning DesignationRow3: Critical AreasRow3: Shoreline DesignationRow3: Any other informationdocuments: Check Box1: OffCheck Box2: OffCheck Box3: OffCheck Box4: OffCheck Box5: OffCheck Box6: OffCheck Box7: OffCheck Box8: OffCheck Box10: OffCheck Box11: OffCheck Box12: OffPrint Name of ApplicantAgent: 20: before me the undersigned a Notary Public in: and for the State of Washington duly commissioned and sworn personally appeared: to me known to be the individuals: described in and who executed the within and foregoing instrument and acknowledged that: WITNESS my hand and official seal this: undefined: 20_2: NOTARY PUBLIC in and for the: State of Washington Residing at: Commission Expires: Print Name of Owner: 20_3: before me the undersigned a Notary Public in_2: and for the State of Washington duly commissioned and sworn personally appeared_2: to me known to be the individuals_2: described in and who executed the within and foregoing instrument and acknowledged that_2: WITNESS my hand and official seal this_2: undefined_2: 20_4: NOTARY PUBLIC in and for the_2: State of Washington Residing at_2: Commission Expires_2:

Documents

Poulsbo, Washingtonin a BLA , unless they meet the statutory exemption provided under RCW 58.04.007 and WAC 458 -61A -109 . SIGNATURES: I, the undersigned, state that, to the best