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' ' ��' � � <br /> RCW 6d.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Streel, Everett,WA 98207 <br /> 425-257-B810—FAX 425-257-8657—vmw everetlwa orq <br /> REHABILITATIVE CONSTRUCTION, NEW CONSTRUCT�QN, RECORDED COVENANT OR CONVERSION <br /> CHECK 3 � Z$ �, f o c�d �'u� v�"r L C 14� 3 -dOq <br /> ONE <br /> Box Property Name Address Building Number Permit Number <br /> O REHABILITATIVE CONSTRUCTION equal to or less thar� 5% or less oi current assessed <br /> market improvement value of specified building' <br /> •NOTE: Applicant to provide entire wsl of rehabilitative construc6on to the building enclosure for a multiunit <br /> residentiai building ur mixed use project per RCW 64.55.010,which may exceed the valuation for bullding permd. <br /> ---- —— — -- <br /> (AJ ENCLOSURE REHAB COST (B)MULTIPIY(A)BY 100 (CJ ASSESSED BUILDING VALUE_4(DJ DIVIDE(8)by(CI =% <br /> _ . . . . . .. I. . . . I . .... ._ _ _. _ _. I . . _ _ _ . <br /> I <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, F2CW 64.55.020 ar�d RCW 64.55.060 <br /> Each buiiding enclosure design documenl 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 certdying that the building enclosure has been inspected during the <br /> course oi construction and has been constructed in substantial compiiance with the builCing enclosure design <br /> documenls. <br /> ❑ RECORDED COVENANT OF SALE from Snohomish County" <br /> 'NOTE: Sale Prohibition Covenant per RCW 64.55.010 <br /> Submit site plan wilh localion ot building,permit wilh descriplion of work and certifled copy o(recorded covenant <br /> from the real property records of Snohomish County, Washinglon for specified building. <br /> ❑ CONVERSION to condominium' <br /> 'NOTE: permits may be required by the City ot Everett per the results of the independenl inspection report. <br /> Undersig�ed will comply wilh owner independent inspeclion altemative per RCW G4.55.090 and RCW 64.34.400(2). <br /> Signature o(Owner or Authonzed Agenl PriNed name of Owner or Authorized Agent Phone# Date <br /> Pnnted name ol Business Address City Zip Code <br /> 2 <br /> chklst-ncw wm and condo(rcv 7/13) FOR OFFICG USG ONLY <br />