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� <br /> RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Ceda�Sheel. Ewrsll,WA 96201 <br /> 425•257-Ee10-F/U(425257-6657-� <br /> REMABILITATIVE CONS7RUCT10N, NEW CONSTRUC710N, RECORDED COVENANT OR CONVERSION <br /> CNECK -r}►e 4Jillews �.so� _Mel.v_ir-t-� Ev_ere� <br /> ONE _- — — <br /> 80% Property Name Addrees Buflding Number Pertnit Number <br /> ❑ REHABILITATIVE CONSTRUCTION eqwl to or I�ss than 5X or less of cu�mnt�ss�ss�d <br /> market improvement valw of sp�cified bufldinp" <br /> 'NOTE: Applicant to provide entire cost of rohabilitative construction to the buildirq enclosum.fa a muRiunk <br /> residential buflding or mixed use projed per RCW 64.55.010,which may ezceed the veluetion�br buflding pertnN. <br /> (AJ ENCLOSURE REHAB C9ST (9)MULTIPLY(A)BY 100 (CJ ASSESSEC BUILDING VALUE .(DJ DIVIDE(B)by{C) =% <br /> � NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to mon than 5X of <br /> current assessed market improvem�nt valw of sp�cifi�d buildinp• <br /> 'NOTE: Per RCW 64.55.010,RCW 64.55.020 and RCW 84.55.060 <br /> Exh building enclosure design document is to be stamped and signed by a Washingto�State archNect.The <br /> documents should also contain e stamped signed statement by tM same erchftect Mat'Me undersigned hes <br /> provided building enclosure documents thet in my professionel judgment are approprfate to setisfy the requfrements <br /> or RCW 64.55.005 through 64.55.090". <br /> Final inspection or 'Certificate of Occupancy' cannat be issued by the building depaRment prior to receipt of a <br /> sipned letter from an independent inspector certifying thet the buildinp enclosure has been inspected during the <br /> course oF construction and has been constructed in substantial compliance with the building enclosure design <br /> documenls. <br /> ❑ RECORDED COVENANT OF SALE irom Snohomish County` <br /> 'NOTE: Sale Prohibition Covenant per RCW 64.55.010 <br /> Submit site plan with location of building, pertnft with description of work and certified copy of recorded covenent <br /> from the real property records of Snohomish County,Washington for specified building. <br /> ❑ CO�NVERSION to condominium" <br /> 'NOTE: permits may be required by the City of Everett per the results of the independent inspection report. <br /> Undersigned w� comply wfth owner independent Inspsction altemative per RCW 64.55.090 and RCW 64.34.400(2). <br /> Signature oi Owner or Authorized Agenl Printed name of Ovmer or Authorized Agenl Phone M Date <br /> --- --------� ---�— ---.—.._-------- <br /> Printed name of Business Address City Zip Code <br /> 4 <br /> chklst-new wm eM coMo(rev 4I23/OB) FOI3 OFFICE USE ONLY <br />