Page 4 of 6
DevSvcs-PMC-1.0-20151112
Accessory Dwelling Unit Application continued...
Affidavit of Owner - Occupancy
I understand that in order to establish an accessory dwelling unit in the City of Kirkland, the property owner must reside
in either the principal dwelling unit or the accessory dwelling unit and the property owner must comply with the
general requirements for Accessory Dwelling Units as specified in the Kirkland Zoning Code. In other words, the
property must be owner-occupied.
“Owner-occupied” means the primary and permanent dwelling place of a person who has an ownership interest in it.
This person lives in such dwelling despite temporary absences, intends it to be his or her legal residence, and intends to
return despite temporary stays elsewhere.
I hereby acknowledge compliance with the owner-occupancy provisions of the Kirkland Zoning Code
, and with all other
general requirements for Accessory Dwelling Units as specified in the Kirkland Zoning Code.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the above answers are true
and complete to the best of my knowledge. I understand that the lead agency is relying on them to make its decision.
Signature of Applicant (Full Name):
Penalty for Violations: In addition to all other penalties provided elsewhere in the Kirkland Zoning Code
, each owner of
a structure who maintains or permits an accessory unit therein in violation of any provision of the Kirkland Zoning Code
shall be subject to civil penalties as specified in the Kirkland Municipal Code.
Alternate Formats: Persons with disabilities may request materials in alternative formats. Persons with hearing
impairments may access the Washington State Telecommunications Relay Service at 711.
Title VI: Kirkland's policy is to fully comply with Title VI of the Civil Rights Act by prohibiting discrimination against any
person on the basis of race, color, national origin or sex in the provision of benefits and services resulting from its
programs and activities. Any person who believes his/her Title VI protection has been violated, may file a complaint
with the City.
To request an alternate format, file a complaint or for questions about Kirkland's Title VI Program, contact the Title VI
Coordinator at 425-587-3011 or titlevicoordinator@kirklandwa.gov.