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RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar Street, Everett, WA 98201 � 1312-�p(p1�07/0(� <br />425-257-8810 — FAX 425-257-8857 — www.everettvra.orq <br />8 r3cZ-G fl 12e� <br />REHABILITATNE CONSTRUCTION, NEW CONSTRUCTIQN, RECORDED COVE�lANT OR CO�VERSiON <br />CHECK CAMELOT APARTMENTS 11030 EVERGREEN WAY, EVERETT WA 98204 A, B, C� jZ�� <br />ONE_.. .. .... _ .. _ _ . .. . . _ _ _ _. __ _. _ . ... .._ ,.. ...�_ .,.. <br />BOX Property Name Address Building Number Permit Number <br />� REHABILITATIVE CONSTRUCTION equal tb or less than 5% or less of current assessed <br />market improvement value of specified buiiding* <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 />_..._ __ _ _ _ __ _ _. <br />_._ .. _, ,..__ <br />(AJ ENCLOSURE REHAB COST (B) MULTIPLY (A) BY 100 (C) ASSESSED BUILDING VALUE (D) DIVIDE (B) by (C) _% <br />$845,000 , $84,500,000 $21,950,000 4.18% <br />❑ NEW C�NSTRUCTION �R REHABILIiATIVE CONSTRUCTION equai to more than 5°Ia 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 enciosure design <br />documents. <br />❑ IRECORDED COVENANT �F 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 />❑ ICONVERSI�N 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 />. ... w.._.. ...... ._. . ....._, _..___... ... ._. __._. . ...... ... _ ...... .. ..... _ . _ , ... . ......._.. .....v.. ......___.._. <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 />_ _ _ _ _ <br />_ _ _.. _ . _ _ _ _. . <br />S/ <br />chklst-new com and condo (rev 7/l3) � FOR OFFICE USE ONLY <br />