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• M III RCW 64.55 BUILDING ENVELOPE SUBMITTAL WORKSHEET CITY OF EVERETT PERMIT SERVICES EVERETT 3200 Cedar Street,Everett,WA 98201 WASHINGTON Phone:425-257-8810 email:everetteps@everettwa.gov website:www.everettwa.gov/permit REHABILITATIVE CONSTRUCTION,NEW CONSTRUCTION,RECORDED COVENANT OR CONVERSION — CHECK MOQMOCIn Vi ew CanctoS 3L125 CO Att Gyve,* WM- - u 21i ONE ) BOX Property Name Address Building Number Permit Number t71 REHABILITATIVE CONSTRUCTION equal to or less than 5%or less of current assessed market improvement value of specified building* *NOTE: Applicant to provide entire cost of rehabilitative construction to the building enclosure for a multiunit residential building or mixed use project per RCW 64.55.010,which may exceed the valuation for building permit. (A)ENCLOSURE REHAB COST (B)MULTIPLY(A)BY 100 w (C)ASSESSED BUILDING VALUE j (D)DIVIDE(B)by(C) = T 2:1 5, 000 2�. o=o_ 8110, 000 3.2 7 % ❑ 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 stamped and signed by a Washington State architect.The documents should also contain a stamped signed statement by the same architect that"the undersigned g has provided building enclosure documents that in my professional judgment are appropriate to satisfy the requirements or RCW 64.55.005 through 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 SALE from Snohomish County(Sale Prohibition Covenant)64.55.010 Submit site plan with location of building,permit with description of work and certified copy ECIEll'!�l 41 1 in real property records of Snohomish County,Washington for specified building. V _. ._______ __ APR 10 2024 � ❑ TOWNHOUSES ON SINGLE PLATTED LOTS(Unit Lot Subdivision) Can submit for building permit while concurrently seeking to obtain unit lot subdivision for each n'io �thiVEREFT is an alternate to providing building enclosure design documents for the townhome building,if theeerniituSeriitietIV approved. Certificate of Occupancy will not be issued without approved subdivision. The applicant accepts the risk involved to obtain a single platted lot exemption to RCW 64.55 for each unit of building. gz. 1m UZS- g -(0696 LI Z Signature of Owner or Authorized Agent Printed name of Owner or Authorized Agent Phone# Date Stynted 12QO An 1°110 ILIy* pvt_iQ wood'�nvtll c �gd_I2 Pri name of Busine s Address City Zip Code SIGNATURE REQUIRED FOR EACH BUILDING PERMIT APPLICATION