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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 — www.everettwa.orq R�HABILITATIVE Ct�NSTRUCTiON, NEW CONSTRUCTION, RECORDED COVENAtiT OR C;ONVER SION . _. _.... �. .. , . . _... CHECK �� C�i �S • A �D�I I R � I ..Y �� oN� l�l a (� }� $ ___ __ �3 � s c� z -03_� _ sOX Property Name Address Buiiding Number I'ermit Num er � REHABILITATIVE CONSTRUCTION equal to or less than 5% or less of currenf assessed market improvement value of specified buiiding�` *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 (C)ASSESSED BUILDING VALUE '(D) DIVIDE (B) by (C) _% .. �(� j� pp� . DO ��3 vD,� ov, �a �' �,��, �00 , o� � �� 5��v � ❑ NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to mor�� th,�n 5% af 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 arc;hiter.t. The documents should also contain a stamped signed statement by the same architect that "the undersigrn�d has provided building enclosure documents that in my professional judgment are appropriate to satisfi� the requirements or RCW 64.55.005 through 64.55.090". Final inspection or 'Certificate of Occupancy' cannot be issued by the building department ��rior 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 buildinca enrlosure design documents. ❑ RECORDED COVEIVANT OF SALE from Snohomish County* "NOTE: Sale Prohibition Covenant per RCW 64.55.010 Submit site plan with location of building, permit with description of work and certified copy of recc�rdeci covenant from the real property records of Snohomish County, Washington for specified building. ❑ CONVERSION to condominium* *NOTE: permits may be required by the City of Everett per the results of the independent inspection report. Undersigned will comply with owner independent inspection alternative per RCW 64.55.090 and I�CVV 64.34.400(2). � ...... .... ..... _.. .. __.. . __ .. . ,. ._. _... ,. _ _ _. __. Signature of Owner or Authorized Agent Printed name of Owner or Authorized Agent Phorie # Date �...... . ._.�... _. _. . _ .. ... _.. _ . . _ . .. . . . . _ _. . .. . _... .. . Printed name of Business Address City Zip Code 4 chklst-new com and condo (rev 4/23/08) FOR OFFICE tJSE ONLY