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letter is submitted that provides evidence of good cause for the waiver. Good cause <br />may include job dislocation, military deployment, sabbatical leave, education, or <br />illness. <br />I, , declare that pursuant to Anacortes <br />Municipal Code 19.47.030(C)(10), I am the landowner of tax parcel # <br />located at <br />and that I am making application to create an Accessory Dwelling Unit that will be in <br />compliance with Anacortes Municipal Code regulations stated above and listed in AMC <br />19.47.030, and requiring that the property owner(s) resides in the principal dwelling unit <br />or the accessory dwelling unit. <br />I hereby certify that the information on this application is true and correct and that the <br />applicable requirements of the City of Anacortes will be met. As property owner(s), I declare <br />that I will notify any prospective purchaser of the occupancy limitations of the Accessory <br />Dwelling Unit as regulated by Anacortes Municipal Code. Furthermore, if any of the <br />provisions of Anacortes Municipal Code 19.47.030 are violated, it is acknowledged that this <br />is cause of the removal of the Accessory Dwelling Unit. I certify under penalty of perjury <br />under the laws of the State of Washington that the foregoing is true and correct and will be <br />addressed should a transfer of property ownership occur. <br />Executed at , Washington this the day of , <br />20 <br />Declarant <br />ACKNOWLEDGEMENT <br />STATE OF WASHINGTON ) <br />SS. ) <br />COUNTY OF SKAGIT ) <br />Declarant <br />On this day of , 20 , before me, the undersigned, a <br />Notary Public in and for the State of Washington, duly commissioned and sworn, <br />personally appeared , to be <br />known to be the individual that executed the foregoing instrument and acknowledged the <br />said instrument to be free and his/her free and voluntary act and deed for the uses and <br />purposes therein mentioned. <br />Witness my hand and official seal hereto affixed the day and year first above written. <br />Notary Public in and for the State of Washington, <br />residing at <br />