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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 REHABILI7ATIVE CONSTRUCTION, NEW CONSTRUCTION, REC(7RDED COVENANT OR CONVERSION ._ .... .. . �. . . .. . CHECK l/�/.� �� CP/ �S • 0 �� K ��_. ��' � . U.._Y � v.��. .�J�� ONE � � __... BOX Property Name Address Building Number Permit Number � REHABILITATIVE CONSTRUCTION equal to or {ess 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 (C) ASSESSED BUILDING VALUE (D) DIVIDE (B) by (C) _% _ _ ��3 D�� va ��3 voov��, �D �� ,��.�, �oo ,a� � �� 5 �� , � ❑ NEW CONSTRUCTION �R 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 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* *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 recorded 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 RCW 64.34.400(2). .. ..... . .... . . .. .._.... �. .. __ . . _. . _.. _ _ Signature of Owner or Authorized Agent Printed name of Owner or Authorized Agent Phone # Date .... __ . _ _ . Printed name of Business Address City Zip Code __ 4 chklst-new com and condo (rev 4/23/08) FOR OFFICE USE ONLY