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l � <br /> RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Sireet, Everett,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everetlwa.ora <br /> REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION <br /> -- — -- -- - _ / --- -- - <br /> CHECK lD9GS/GQD� �tLI'9/ ++ Mw� �¢ <br /> ONE _��j�.7�fl�,i � _r_-J� - N C�O���C2�.�. <br /> BOX Prorierty Name Address Building Number Permit 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 provide entire cost of rehabilitative construction to the building enclosure for a multiunit <br /> residential buiiding or mixed use project per RCW 64.55.010, which may exceed the valuation for building permit. <br /> (AJ ENCLOSURE REHAB COST (8)MULTIPLY(A)BY 100; (CJ ASSESSFD BUILD�NG VALUE :(D)DIVIDE (B)by(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 64.55.060 <br /> Each building enclosure design document is to be stamped and signed by a Washington State architect. The <br /> documents should also contain a stamped signed statement by the same architect that"the undersigned has <br /> provided building enclosure documents that in my pro(essional judgment are appropriate to satisfy the requirements <br /> or RCW 64.55.005 through 64.55.090". <br /> Final mspection or 'Certificate of Occupancy' cannot be issued by the building department prior to receipt of a <br /> signed letter from an independent inspector certifying that tlie building enclosure has been inspected during the <br /> course o( consVuction and has been constructed in substanlial compliance �vith lhe building enciosure design <br /> documents. <br /> ❑ RECORDED COVENANT OF SALE from Snohomish County' <br /> 'NOTE: Sale Prohibition Covenant per RCW 64.55.010 <br /> Submit site pian wilh location of building, permit with description of work and certified copy of recorded covenant <br /> (rom the real property records of Snohomish County, Washinglon for speciFied building. <br /> ❑ CONVERSION to condominium' <br /> 'NOTE: permits may be required by the City of Everett per the results of the independent inspection report. <br /> Undersigned will comply with owner independent inspection alternative per RCW 64.55.090 and RCW 64.34.400(2). <br /> :'e�/" /v_1�1{tl���..� �j�CK �1�5 R )c��1�17 ��',Zv1a.. <br /> Signature o/Owner orAuthorized Agent Prinfed name of Owner orAuthorized Agent Phone# Date <br /> _�e��,,dv zw c��_r_�,_�.� �t O ��X d2o`�3 tver�.t{- 98ar.3 <br /> Printed name of Business Address City Zip Code <br /> chkls4new com and condo(rev AI23/OB) FOR OFFICE USE ONLY <br />