3326 LOMBARD AVE 2016-01-01 MF Import

RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET CITY OF EVERETT PERMIT SERVICES � 3200 Cedar Slreet, Everefl,�NA 98201 425-257-8810–FAX 425-257-8857–vNnv everellvra.orq REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION CONEK ��e�e r�-----�s�-- 332(� �o/��Q� 13 �3a�-o� I BOX Property Name Address Building Number Permit Number REHABILITATIVE CONSTRUCTION equal to or less than 5% or les> of current assessed market improvement value of specified building* 'NOTE: Applicant to provide entire cost of rehabilitative construction to the buiiding erciosure for a multiunit residential building or mixed use project per RCW 64.55.010, which may exceed the v�luation for building permit- (A) ENCLOSURE REHAB COST�(B)MULTIPLY(A) BY 100 Cj ASSESSED BUILDING VALUE (D)DIVIDE (B)by(C) _% �o I o I 3.5 T'/tj �35000. �3�0 ��000. � ��Q�� QQO.00 , ❑ NEW �ONSTRUCTION OP. REHABILITATIVE CONSTRUCTION e��ual to more than 5% of current assessed market improvemen4 value of specified building" `NOTE: Per RCW 64.55.010, RCW 64.55.020 and RCW 64.55.060 Each building enclosure design document is to be stamped and signed by a Washington State architect. The documents should also contain a stamped signed statement by the same architect that"the undersignad has provided building �nclosure documents ihat in my professional judgment are appropriate to satisfy the requirements ar RCW 64.55.('J5 through 64.55.090". Final inspection or 'Certificate oi Occupancy' cannot 6e issued by the building department prior to receipt of a signed Ietter from an independent inspector cerlifying that the building enclosure has been inspected during the course of construction and has been constructed in substantial compliance with the building enclosure design documents. ❑ RECORDED COVENANT OF SALE from Snohomish County"` "NOTE: Sale Prohibition Covenant per RCVJ 64.55.010 Submit site plan with location of building, permit with description of work and certified copy of recorded covenant from the real property records of Snohomish County, Washington for specified building. ❑ CONVERSION to condominium* "NOTE: permits may be required by the City of Everett per the results of the independent inspection report. Undersigned ' o{n with owner independent inspection alternative per RCW 64.55.090 and RCW 64.34.400(2). � (. (S iqti�l�� ? �3�f�-p�00 �,� Signature o wne orAuthorized Agent Printed name of wner Authorized Agent Phor.e# Datc !� �o�i3 (�� /G�/ �i�,�r�rE� p8z? � ' Printed name of Dusiness Address Cily Zip Code i � -------- ------_ -- _ — -- '/ -- - _-- chklst-new com and condo(rev 4/23108) FOR OFFICE USE ONLY Y�