Fillable ABOUT THE CONCURRENCY TEST DEFERRAL AFFIDAVIT Submittal Instructions (City of Sammamish)

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ABOUT THE CONCURRENCY TEST DEFERRAL AFFIDAVIT Submittal Instructions (City of Sammamish)

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801 228
th
Ave NE
Sammamish, WA 98019
425-295-0500 | www.sammamish.us
2019-CTDA-01 Page 1 of 3
CONCURRENCY TEST DEFERRAL
AFFIDAVIT
ABOUT THE CONCURRENCY TEST DEFERRAL AFFIDAVIT
Submittal Instructions
Complete & save this form
before uploading it to
MyBuildingPermit.com in the
“File Upload” section along
with the rest of the submittal
documents.
Code Reference
Application for Certificate of
Concurrency
SMC 14A.10.020(1)
Questions?
Submit Project Guidance
Visit the Permit Center
City of Sammamish
801 228th Ave SE
Sammamish, WA 98075
www.sammamish.us
Sammamish Municipal Code 14A.10.020(1) requires (with some
exceptions) applicants requesting a Comprehensive Plan Site-Specific Land
Use Map Amendment or Zone Reclassification to either apply for a
Certificate of Concurrency or submit a Concurrency Test Deferral Affidavit.
This affidavit form is to be completed by applicants and submitted with
their application (as relevant). The affidavit acknowledges that a
Concurrency Test is required but that it will be completed at a later time.
2019-CTDA-01 Page 2 of 3
CONCURRENCY TEST DEFERRAL AFFIDAVIT
AFFIDAVIT
Notary is required for this affidavit.
T
he undersigned, being first duly sworn on oath deposes and says
A.
I am/We are over the age of eighteen (18) years and competent to be a witness herein.
B.
I/We have applied for a
(application type)
from the City of Sammamish, Washington for the following property or properties:
Property Address(es):
Parcel Number(s):
C.
I/We hereby declare and affirm that I/we elect to defer the Concurrency Test required by
Chapter 14A.10 of the Sammamish Municipal Code for the above listed property/properties
until a later time.
I
/We understand and acknowledge that the above listed property will be subject to th
e
Concurrency Test and successful receipt of Concurrency Certificate as provided in
SMC14A.10 before any development permit may be applied for.
I
/We also understand and acknowledge that the City of Sammamish’s issuance of a Map
Amendment or Zone Reclassification without a Concurrency Test creates no “vested rights”
or other rights to develop the subject property.
I/We certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Signature(s):
Date:
Signature(s):
Date:
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2019-CTDA-01 Page 3 of 3
CONCURRENCY TEST DEFERRAL AFFIDAVIT
WASHINGTON NOTARY ACKNOWLEDGEMENT
STATE OF WASHINGTON
County of King
Signed and sworn to/affirmed before me on
(date)
by
(name(s) of individual(s) making statement)
(Stamp)
(Signature of Notary Public)
(Title of Office)
My Commission Expires:
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ABOUT THE CONCURRENCY TEST DEFERRAL AFFIDAVIT Submittal Instructions (City of Sammamish)

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Completed 24 January 2021

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