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W <br />� <br />� <br />RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar Street. EvPretl, WA 98201 . <br />425-257-881D - FAX 425-257•88�' - wvnv everethva ora <br />NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION <br />CNECK .F-E;Q PiJoTAL PD�rn ���s II�O'�r_�N� �r�N� <br />ONE <br />BOX PropertyName .ldtlress ��yC-'rT WP R <br />i�3oA <br />(�I 3��-o I <br />Buildmg Numher Pertnn Number <br />❑ REHABILITATIVE CONSTRUCTION equal to or less than 5% or less of current assessed <br />market improvement value of speciFied building' <br />'NOTE Applicant to prowde eMire cost of rehabilitative conslruction to the buildmg enclosure for a multiunit <br />res�deMial buildmg or mized use project per RCW 64.55D70, which may exceed the valuatlon for building permit. <br />AIULTIPLY (A1 BY 700 I!CI ASSESSED DUILDING VALUE I(D) DIVIDE (B) bY lCl =% <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 64.55.060 <br />�n <br />❑ <br />Each bwlding enclosure design document is to be stamped and signed by a Washmglon State architect The <br />documenls should also contain a slamped signed statement by the same architect ;hat "the undersigned has <br />proviaed bwlding enclosure documents that in my professional judgment are appropriate lo satisfy the reqwrements <br />or RCW 64 55 005 lhrough 64 55 090" <br />Final inspection or 'Certificate of Occupancy' cannot be issued by the budding department prior to receipt o( a <br />signed letter from an independent inspecror certifying �hat tha building enclosure has been insp�cted durinc the <br />course of construct�on and has been constructed m substantial compliance with ihe building enclosure design <br />documents. <br />RECORDED COVENANT OF SALE from Snohomish County' <br />'NOTE Sale Proh�bihon Covenant per RCW 64 55 010 <br />Submd sde plan with IocaUon of butlding, permd wdh descnpUon of work ard certdled copy ol recorded covenant <br />(rom lhe real property records of Snohomish Crunty. Washington for sf-ecdied 6uilding <br />CONVERSION to condominium' <br />'NOTE permds may be requued by the Cdy of Evarett per the results of the �ndependent mspection report <br />Unders�gned will comply �vdh owner independent inspectiun alternalive per RCW 64 SSA90 and RCW 64 34 400(2). <br />Signature of Owner or Aulho�i7.ed Ag n; <br />l��-�i QRL�,n ll�'•o iS � � 01 <br />Pnnted name of Busines5 � <br />rh},lu-nr�c:omand:ocJoiic� ;':�Si <br />STp N l o}�-n rJ � <br />Prmted name of Owner or Au honzed Agent <br />P�1�-G Sf �l '� sEpr� <br />Address City <br />4 <br />�G�?�.��33�2 y�l��r�; <br />Pnone p Datc � <br />� �b'1 Z�_ I <br />Zip Code , <br />F(1K Ol�ll(�P. i1SlC (l�l }. <br />