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1 '� <br /> RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br /> CITY OF EVERETT PERMIT SERVICES <br /> I, 3200 CEDAR STREET,EVERETT,WA 98201 <br /> 425�257-8810—FAX 425-257-8857—�•:ww i+ve�eitwa gry <br /> VALUATION MAXIMUM, RECORDED SALE PROHIBITION, CONVERSION, OR FULL COMPLIANCE <br /> ICHECK <br /> oHe ����. � r��q��„�� �S..7y G�<=����..1" � '� l_`1 �O�C�S (,G '�. <br /> I BOX property Name Addiess BuiWing Number Permit Number <br /> � f� vALUATION of 5% or less oi current assessed value (per building permit application) <br /> j Comply with RCW 64.55.020(1). Reler to Everett Municipal Code for adrlitional permit requirements. Submit site <br /> I plan with location of building and permit with description of work. Calculate pe�cent valuation divided by current <br /> assessed structure value. <br /> MULTIPLY CONTRACT PRICE OF WORK BY 100 DIVIDE BY ASSESSEO VALUE RESULTING PERCENTAGE <br /> A ,t > <br /> O//l� � C'`/ <br /> > c��13 ;��� <br /> ❑ RECORDED Snohomish County Sale Prohibition Covenant, minimum 5 years <br /> Comply with RCW 64.55.010(10). Refer to Everett Municipal Code for additional permit requiremants. Submit <br /> site plan with location of building and permit with description o1 work. Submit covenant recorded i�the real <br /> property records ol Snohomish County,Washington, in satislaction of the requirements ol RCW 64.;;5.010 <br /> II through 64.55.090. The covenant idemilies the sole owner of the property described on Exhibit A(the"Property). <br /> i Unt�l termination o1 the covenant, no dwelling unit in or on the Property may be sol�as a condominium unit exCept <br /> � lor sales listed m RCW 64.34.400(2). <br /> � CONVERSION to condomintum (owner fnspection alternative) <br /> ; No permit required il complying with HCW 64.55.090 and RCW 64.34.400(2�. Reter to Everett Municipal Code for <br /> additional permit requirements. <br /> S�gnature ol pwnei or Aulhorix.d Agent Prinled name ol Owner or Aulhorized Agent Phone N Dale <br /> � Pr�nted name o1 Business Address City Zlp Code <br /> ❑ FUL� COMPLIANCE with RCW 64.55.005 through 64.55.090 <br /> Ali building enclosure design documents to be stamped and signed by a Washington State Architect or Engineer <br /> 1or compl�ance with all applicable codes, including modilications to the documenis that become addenda or <br /> change orders to alter those documents, per RCW 64.55.010 (1 t). Buitding enclosure design documents are to <br /> contain a stamped statement by the architect or engineer that "the undorsigned I�as provided building enclosure <br /> documents that in my profess:�nal judgment are appropriate to satisfy the requirements or RCW 64.55.005 <br /> through G4.55.090", per RCW 64.55.020. <br /> Finai �nspection or Certificate o1 Occupancy will not be issued without a signed letter irom an independent <br /> mspector certilyinq that the building enclosure has been inspected during the course of construction and has been <br /> constructed in substantial compliance with the building enclosure design documonts,per RCW 64.55.060. <br /> Upda�etl 10i2��0% FOR OFFICE USE ONLV <br /> , � . . , - �) � . <br /> �/�/S ( � , � „IC_ __._ <br />