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RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Street, Everett,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.ora <br /> REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION <br /> CHECK ttt��� � 1 ^C f,,�t� 1� ��., <br /> —. �c9 dS%G407 J'�«re� .0 •+...� � <br /> ONE �L;4�.T fn'T � r � — C7 �'O�I'V�sT�Lf.� <br /> eOX Pro�eriy Name Address Building Numher 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 building or mixed use project per RCW 64.55.010,which may exceed the valuation for building parmit. <br /> (A)ENCLOSURE REhIAB COST!(8)MULTIPLY(A) BY 100 C ASSESSED BUILDING VALUE (D)DIVIDE(B)by(C)=%a_ <br /> - - I I <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 G4.55.020 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 conlain a stamped signed statement by the same architect that"lhe undersigned has <br /> provided building enclosure dowments that in my professional judgment are appropriate to satisfy the requirements <br /> or RCW 64.55.005 through 64.55.090". <br /> Final inspeclion or 'Certificate of Occupancy' cannot be issued by the building department prior to receipt of a <br /> signed letter from an independent inspector certi(ying that the building enclosure has been inspected during the <br /> course of construction and has been constructed in substantial compliance with the building enclosure design <br /> documents. <br /> ❑ RECORDED COVENANT OF SALE from Snohomish County* <br /> 'NOTE: Sale Prohibition Covenant per RCW 64.55.010 <br /> Submit site plan with location of building, permit with description of work and certified copy of recorded covenant <br /> (rom the real property records of Snohomish County, Washington (or 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 /> =�s��' ��� (�t�,l LCY� ��.25 -c`17o-71`l7 ��',2Y•.7a,.- <br /> Signature o/Owner or Authorized Agent Printed name o/0wner orAufhorizedAgent Phono# Date <br /> �Ovnc�V' zw �;,�i�.�.4s.� �O bClx �O`(3 �=U�-�ff' S8�2r3 <br /> Printed name of Business Address City Zip Code <br /> chklsl-new com and condo(rev 4/23108) FOR OFF�CE USE ONLY <br />