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� <br />�.J <br />RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br />E � CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar ;:t�eet, Everett, WA 98201 <br />425•257-8810 - FAX 425-257-8857 - v.�^nv evere�trra or� <br />REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION <br />CHECK <br />ONE <br />BOR Prcperty Name <br />Address <br />Bwlding Number Permd �!�mber <br />❑ REHABILITATIVE CONSTRUCTION equal to or less than 5% or less of �urrent assess�d <br />market improvement value of specified building' <br />'NOTE Applicant ro provide entire : ost of rehabihtative construrtor to the building enclosure for a multwnd <br />residential huilding or mixed use proje� � per RCW 64 55 010, which may er-eed lhe vaivation toi bmlding permit. <br />------------------ _ _ <br />(A) ENCLOSURE REHAB COST�(8) P.IULTIPLV (A) BY 100 �(C/ AFo'ESSED 6l�IL�ING VALUE (OJ DIVIDE (0) by (C) = 90 <br />u <br />C <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, RCW 64.55.020 and RCW 64.SSA60 <br />Each building enclosure design documenl is to be stamped and signed by a W:ishington State architect. The <br />documents should also contain a stamped signed statement by the same arch lecl that 'the undersigned has <br />provided building enclosure documents lhat in my professional judgment are ,,�propriate lo satisfy the requiremenls <br />or RCW 64.55.005 through 64.55.090". <br />Final inspection or 'CeroLcate of Occupancy' cannot b� issued by the building department prior to receipt of a <br />signed letter from an independent inspe.tor certifying that the building enclosure has been inspected during the <br />course of conslruclion and has been construcled m substanlial compliance �vilh the building enciosure desi�n <br />documents. <br />RECORDED COVENANT OF SALE from Snohomish County' <br />'NOTE: Sale Prohibition Covenant per RCW 64.55.010 <br />Submd site plan with localion of buildin9, permit with description of work and certified copy of •zcorded covanant <br />froni the real property rewrds ot Snohomish County, Washington for specifed building. <br />❑ I COVVERSION to condominium" <br />'NOTE. F ermits may be required by the City of Everett per the results of the indepenaent inspection report. <br />Undersi3ned will comply with owner independenl inspection allemative per RCW 64 55.090 and RCW 64.3M1.400(2). <br />SignaWre of Ownr ar Aulhorized Agent Printed name of Owner or Authonzed Agent Phone # Dale <br />Printed name of Business <br />chklst-nr.v min a:id eondo (rev J/'3,OS1 <br />Address <br />�ity <br />I'O�i OPFICE US8 ONLY' <br />Zip Code <br />� <br />