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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 />CHECK - `� ��; n '1 <br />ONE v�T� C�E�.� � s'�c�TIL�_.^' `-S ....v_.��4U_I.. 3r�..%��E . ��._, % __. �7�c'���._..�L`t; .. <br />_ _. . . _. <br />BOX Property Name Address ���� \�!Q ���� Building Number Permit Number <br />C� 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 />__. . . _.__. . ... _ ... <br />(A) ENCLOSURE REHAB COST (B) MULTIPLY (A) BY 100 (C) ASSESSED BUILDING VALUE (D) DIVIDE (B) by (C) _% <br />� <br />■❑ <br />�� i'� ?r� C N'� (� <br />NEW GONSTRUCTION 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 />❑ ICONVERSION 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 />_ _ .. . _ . _ . . _ .. . ._. .. . . _ .. _ ._.. . . . .. _. . . _ . . . .. _ . _ ._ <br />Signature of Owner or Authorized Agent Printed name of Owner or Authorized Agent Phone # Date <br />__ . _ <br />Printed name of Business Address <br />4 <br />.,_ . . _ <br />City Zip Code <br />