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i - ---- - - <br /> RCW 64.55 MULTI-FAMILY CERl'IFICATION WORKSHEET <br /> CITY OF EVERETT PERMIT SERVICES ' <br /> � 3200 Cetlar Slreel, fveretl.WA Oa201 <br /> � 425-257-fl810-FN(425�257�8857-v�y eyrreuh.a_uig <br /> I <br /> REFIABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION <br /> CONEN T�Y-�-A���(� � I � IS w, �As�ist� ��. /�3 . (3i3a r -03'T/ <br /> BOX PropeAy Namc Address BuAAmg Number Pennd NumbBr <br /> Cl REHABILITATIVE CONSTRUCTION equal to or less than 5% or less of current assessed <br /> market improvement value of specified building' <br /> 'NOTE Appbcant to provide entire cost of rehabAitahve construchon to the budding enclosure for a mulhunit <br /> � residential build�ng or mixed use pro�ect pei RCW 64 55 010,which may exceed the valuation tor b•.;Jding permit <br /> i (Af�NGLOSURF.REHAA COST /B)fdUL71PLY (�1)BV 100 (C)ASSESSFD OUIL6INC VALUC (D/DIVID[(!3)by�C) _ "o <br /> I <br /> I — --------- <br /> i ❑ NEW CONSTRUCTION OR REHA8ILITATIVE CONSTRUCTION equal to more lhan 5% of <br /> � current assessed market improvement value of specified building' <br /> ' 'NOTE Per RCW G4 55 010, RCW 64 55 020 ard RCW 64 55 OEO <br /> � Each buddmg enr,losure design document is to be stamped and signed by a Washington State archltect The <br /> ; documents should also conlain a stamped s�gned slalement by the same archit_;t Ihat'the undersigned has <br /> � provided building enclosure documenis that in my professional�udgment are appropnate lo satlsfy lhe reqwrements <br /> or RCW 64 SSA05 through 64 55 090'. <br /> I Final inspection or Cert�ficate of Otcupancy' cannot be issued by the bwlding depanrnent prior to receipt of a <br /> signed letler from an mdependent inspector certitymg Ihat the bwlding enclosure has been mspected dunng the <br /> course of construction and has been constructed �n substantial compiiance wAh lhe building enclosure design <br /> documents <br /> --— -' <br /> --�----�—�-- �-- --�—�-- — �— — i <br /> ❑ RECORDED COVENANT OF SALE from Snohomfsh County' <br /> i 'NOTE Sale Proh�bdion Covenant per RCW 64 55 O10 <br /> �'� Submd sde plan vnth location ol bwld�ng, permd vnth description o(work and cerldied copy ol recorded covenant <br /> Irom Ihe real property records of Snohomish County, Washmglon lor specd�ed bwlA�ng <br /> ❑ CONVERSION to condominium' <br /> 'NOT[- permils may be required by the Gdy ol Everett per ihe resutts ol lhe independenl inspedion report. <br /> Undersigned vnll comply vnth ewner mdependenl inspr.ctmn attemalive per RC W 64 55 09D and RCW 64 04 400(2). <br /> I <br /> i <br /> Signature ol Ownei or�ulhoutcA�genl PunlcA namr.ot Owner or Aulhorzed Ayeni Phonc N �atc <br /> Prmted name ol Business AdAress CAy Z�p Code <br /> 2 <br /> chAP.i�nc�� c�nn anJ r�mdn Urv L 171 I�OH��I PICP I itiP�INI,}. <br /> - -- - - ��-- - - - . _.. . -- -� - �— -- <br />