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a ,. <br />RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar Street, Everett, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.orq <br />REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION <br />CONEK ,ilr�r��,ti j�<,sf���� �'�Ytit; �,� �'«_� �` �c�.��7—a33 <br />BOX Property Name Address Building Number Permit Number <br />LJ REHABILITATIVE CONSTRUCTION equal to or less than 5% or less of current assessed <br />market improvement value of specified building* <br />*NOTE: Applicant to provide entire cost of rehabilitative construction to the building enclosure for a multiunit <br />residential building or mixed use project per RCW 64.55.010, which may exceed the valuation for building permit. <br />(A) ENCLOSURE REHAB COST (B) MULTIPLY (A) BY 100 (C) ASSESSED BUILDING VALUE (D) DIVIDE (B) by (C) _% <br />� -7 (�' S �-' `'�� .z �7 � �D G`�J � � �' C �' e`�`�` � � �,� � � `�' <br />,� " <br />❑ NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to more than 5% of <br />current assessed market improvement value of specified building* <br />*NOTE: Per RCW 64.55.010, RCW 64.55.020 and RCW 64.55.060 <br />Each building enclosure design document is to be stamped and signed by a Washington State architect. The <br />documents should also contain a stamped signed statement by the same architect that "the undersigned has <br />provided building enclosure documents that in my professional judgment are appropriate to satisfy the requirements <br />or RCW 64.55.005 through 64.55.090". <br />Final inspection or `Certificate of Occupancy' cannot be issued by the building department prior to receipt of a <br />signed letter from an independent inspector certifying that the building enclosure has been inspected during the <br />course of construction and has been constructed in substantial compliance with the building enclosure design <br />documents. <br />❑ RECORDED COVENANT OF SALE from Snohomish County* <br />"NOTE: Sale Prohibition Covenant per RCW 64.55.010 <br />Submit site plan with location of building, permit with description of work and certified copy of recorded covenant <br />from the real property records of Snohomish County, Washington for specified building. <br />❑ CONVERSION to condominium* <br />*NOTE: permits may be required by the City of Everett per the results of the independent inspection report. <br />Undersigned will comply with owner independent inspection alternative per RCW 64.55.090 and RCW 64.34.400(2). <br />Signature of Owner or Authorized Agent Printed name of Owner or Authorized Agent Phone # Date <br />_ <br />Printed name of Business Address City Zip Code <br />2 <br />chklst-ncw com and condo (rev 7/13) FOR OFFICE USE ONLY <br />