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. , � � <br /> RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Street, Everetl,WA 98201 <br /> 425-257-8810–FAX 425-257-8857–www.everettwa ora <br /> REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION <br /> CHECK 31LB nPopdw�, U,v�t A ��4�3 -00 � <br /> ONE _ --_ — _.— _ <br /> BOX Property Name Address building Number Pertnit Number <br /> ❑ REHABILITATIVE CONSTRUCTION equal to or less than 5% or less of curr:nt assessed <br /> market improvement value of specified buifding' <br /> 'NOTE: Applicant to provide entire cost of rr.habilitative construction to the building enclosure for a multiunit <br /> residential building or mixed use project per RCW 64.55 010,which may exceed lhe valuation for building permil. <br /> —�------� – ------- ------------- -�. __..— <br /> (AJ ENCLOSURE REHAB.COST (B).MULTIPLY(A)BY 100 i(CJASSESSED BUILDII�IG VALUE I(D)DIVIDE(B)_by(C) _%_ _ <br /> . . . _. _ . . . I . .. _ . . ._. . . I .. . . . <br /> � NEW CONSTRUCTION OR REHABIL{TATIVE CONSTRUCTION equal to more than 5% of <br /> current assessed market improvement vaiue 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 statemenl by the same architect that"the undersigned has <br /> provided building enclosure documents thal in my professional judgment are appropriate to satisfy the requirements <br /> or RCW 64.55.005 lhrough 64.55.090". <br /> Final inspection or 'CeAificate oi Oaupancy' cannot be issued by the building department prior to receipt of a <br /> signed letter fram an independent inspector certirying that the building enclosure has been inspected during the <br /> course of construction and has been constructed m substantiat compliance with the building enclosure design <br /> documenls. <br /> ❑ RECORDED COVENANT OF SAL� from Snohomish Gounty" <br /> 'NOTE: Sale Prohibition Covenant per RCW 64.55.010 <br /> Submil site plan with location of building, permit with description oi work and certified copy of recorded covenant <br /> from lhe real property recotds of Snohomish County, Washington for specified building. <br /> I ❑ CONVERSION to condominium" <br /> 'NOTE: permits may be requiied by Ihe Ciry of Everetl per lhe resulls of the independenl inspection repoR. <br /> Undersigned will comply with owner independent inspection altemative per RCW 64.55.090 and RCW 64.34.400(2). <br /> Signature of Owner or Authorized Agent Printed name of Owr.=r or Authorized Agent �Phone# Date <br /> Printed name of Business � Address �City ^ Zip Code <br /> 2 <br /> chklst-ncw com and condo(rcv 7/13) FOR OPPICL'USE ONLY <br /> ,, <br />