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RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET CITY OF EVERETT PERMIT SERVICES 3200 Cedar Street, Everett,WA 98201 425-257-8810-FAX 425-257-8857-%,wm.everettwa,orq REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION CHECKFIR ' D ltfri 77- ve(Zarr• 3b f D ?Ott Box Property Name Address IN3o I _307 3a i 8 ONE ' -) Building Number / Permit Number „ , ❑ REHABILITATIVE CONSTRUCTION equ "o or less than 5% or less of current assessed market improvement value of specified 6u ding* 'NOTE: Applicant to provide entire cost of rehabiliitatfve construction to the building enclosure for a multiunit residential building or mixed use project per ROW 64.55.010,which may exceed the valuation for building permit. (A)ENCLOSURE REHAB COST (B1MULTIPLY(A613'0100 (C)XISSESSED BUILDING VALUE (D)DIVIDE(B)by(C) =% NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to more than 5% of current assessed market Improvement value of specified building* 'NOTE: Per RCW 64.55 010 RCW 64.55.020 and RCW 64•55.060 Each building enclosure design document Is to be stai •ed al• _ us;. • = A :. in• •. tate : - The documents should also contain a stamped signed statement by the same architect that the undersigned has provided building enclosure documents that in my professional judgment are appropriate to satisfy the requirements or RCW 64.55.005 throligh 64.55.090". Final inspection or 'Certificate of Occupancy' cannot be Issued by the building department prior to receipt of a signed letter from an independent inspector certifying that the building enclosure has been inspected during the course of construction and has been constructed in substantial compliance with the building enclosure design documents. ❑ RECORDED COVENANT OF SAL- ro�i nohomlsh County* *NOTE: Sale Prohibition Covenant per ROW 5.010 Submit site plan with location of building, •: mit h description of work and certified copy of recorded covenant from the real property records of Snoho;ash Coun- ,Washington for specified building. ❑ CONVERSION to condominium 'NOTE: permits may be required by the City o Everet per the results of the independent inspection report. Undersigned will comply with owner independent 1.spection alternative per RCW 64.55.090 and RCW 64.34,400(2). Signature of Owrt .t o'rAuthorized Agent ,Tinted name o Owner or Authorized Agent Phone# Date — Printed name of Business Address City -- -_- Zip Code 2 chklst-new corn and condo(rev 7/13) FOR OFFICE USE ONLY 33