Medina, WA · King County
Owner’s Declaration of Agency
Property owners or contract purchasers use this form to declare who will act as their agent for permit applications and project coordination in Medina.
What this form is
Use this form when applying for one or more permits for development of the listed property. It identifies the owner or authorized representative, names the person acting as agent or allows the owner to act as their own agent, and records agreement to project requirements. The form asks for the project address, parcel number, names, signature, and date; an entity representative must attach proof of appointment.
Who needs it
Owners or contract purchasers applying for development permits, or an authorized officer or representative of an entity that owns the property, use this form.
How to submit it
Submit it to Development Services, 501 Evergreen Point Road, Medina, WA 98039. The form lists phone numbers 425-233-6414 and 425-233-6400.
About notarization
This document is signed and dated without a notary; the signer just signs and dates it, and the form does not say any attachment must be notarized or sworn.
How to submit this form
- 1
Download the Form
Download the Owner’s Declaration of Agency for the property development permit application.
- 2
Complete the Form
Enter the project address and parcel number, identify the owner or representative, select the agency arrangement, and sign and date.
- 3
Gather Attachments
If an entity representative signs, attach a copy of the Power of Attorney or other document showing appointment.
- 4
Submit to Development Services
Submit the form to Development Services at 501 Evergreen Point Road, Medina, WA 98039.
Frequently asked questions
- Do I need a notary for the Owner’s Declaration of Agency?
- No. The form provides a signature and date line and does not require notarization. If an entity representative signs, attach the stated proof of appointment; the form gives no notary requirement for it.
- Who can name an agent on this form?
- An owner or contract purchaser can appoint an agent to handle permit application processing, review and approval, revisions, inspections, and project approvals, or can act as their own agent.
- What should I attach to the form?
- An officer or representative of an entity that owns the property must attach a copy of the Power of Attorney or other document showing their appointment.
- How do I submit the Owner’s Declaration of Agency?
- The form lists Development Services at 501 Evergreen Point Road, Medina, WA 98039. It also lists phone numbers 425-233-6414 and 425-233-6400.
Need something notarized?
This Owner’s Declaration of Agency doesn’t need a notary — but if you have another Medina form that does, a commissioned online notary can help.