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i -- -- -- ------ <br /> � _ - - -- - ----- - - - - -- --- - - I <br /> I RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br /> ,Ej� CITY OF EVERETT PERMIT SERVICES <br /> � 71C0 Cedai Slreet, fvcretl.WA 98201 <br /> 425�257�fl910-FAX 4<5�257.BG57 -w�v,v NVPret."h�a n�g <br /> REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION <br /> ICONE� T��-�-����1�P � I�� i, ��, �as� �v �� n . � �3 �3o4 -o3s <br /> 00K Pmperty Name �dAress BmlEin�Number Permit Number <br /> I C] REHABIUTATIVE CONSTRUCTION equal to or less than 5% or less of current assessed I <br /> imarket improvement value of specified building' i <br /> , 'NOTE Appl�cant to provide enhre cost o1�ehab�l�latwe conslruct�on lo the bu�iding enclosure tor a multiunit <br /> j residential bwldmg or mi�ed use pro�ect per RCW 64 55 010, which rr�ay ezceed the valuation(or bwlding permit I <br /> i (A)[NCLOSUR[ REHAB COST�(BJ MULT'�PLY(A)[3V 100 (C/ASSCSS[D f3U1L01NG VAIUC (D)DIVIUc �0) by(C1 = 'b i <br /> I -- ------' ---- --------� - — --- -- ---. . .----- � <br /> i ❑ NEW CONSTRUCTION OR REHABIUTATIVE CONSTRUCTION equal to more than 5% of <br /> current assessed market improvertient value of specified building' <br /> � 'NOTE Per RCW G4 55 010. RCW 64 55 020 and RCW 64 55 060 <br /> � Each bwlding enciosure design document is to be stamped and 5igr.ed by a\Nashmgton State architect The I <br /> documenls should also contam a stamped signed statement by the same archdect Uat 'Ihe undersigned has <br /> I provided bwldmg enclosure documents Ihat m my professional�udgmenl are appropnate to sa�isfy the requirements � <br /> '� or RC W 64 55 005 through 64 55 090'. I <br /> I <br /> Final mspection or Certificate of Occupancy' cannot be issued by the bu�lding department prlor lo receipt ol a � <br /> j signed leder Irom an �ndependent inspecta certdymg that the bu�.lding enclosure has been inspected dunng the � <br /> course of consiruction and has been conslructed �n substanUal compl�ance w�th Ihe hmlding enclosure design � <br /> � documents � <br /> -- - -`-�------ ------ ------� - ---- -- - - - -------. . _- <br /> I ❑ RECORDED COVENANT OF SALE irom Snohomish County <br /> ' 'NOTE. Sale Proh�b�6on Covenant per RCW 64 55 010 <br /> ISubmd sde plan vnth lacat�on o(butldmg, permit wdh descnplion of work and ceA�fied copy of recorded covenant <br /> IIrom the real praperty records of Snohomish County, Washington lor speciGed bwlding. - <br /> ❑ CONVERSION to condominium' I <br /> I 'NOT E permits may be reqwred by the Gity o�E-veretl per Ihe results o11he�ndepenCent inspection report <br /> Undersigned will comply with owner indepe�dent mspection alternatwe per RCW G4 SSA90 and RCW G4 34 400(2� I <br /> IS�yn:� �re ol Owner or Authonzed Ayent Pnnted name ol Owner or 4uthonmA Agent Phonc N Datc li <br /> I <br /> I Pnnled name of Dusiness Adtlrcss Clry Zip CoAe I <br /> 2 <br /> chAl.t-nc��cum and.andu�tcc 7/I il f�qi�q�PI('I�.1!tif�INI.1" <br /> � <br />