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r , gOsv�4-O�7 <br />, <br />RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar Slreet, Everett, WA 98201 <br />425-257-8810 — FAX 42F-257-8857 — w�w+.everethva.ora <br />REHABILITATIVE <br />NEW <br />OR CONVERSION <br />ONEK l.R�e`'j s�fl..r _. �pf. . _.3_`�i1�lo �Vif".o�kr_ _..El�iRef�!!/�� ----------- ---.8_0`7�41?__ .. <br />BOX Property�Name Address Building Number Pormil Number <br />n <br />■� <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 comply with RCW 64.55.010 for estimaling vaiue of construction work on lhe building <br />enclosure <br />(AJ PERMIT CONTRACT PRICE (B) MULTIPLY (A) BY 7001 (CJ ASSESSED BUILDING VALUE (OJ DIVIDE (B) by (C) =%_. <br />NEW CONSTRUCTION OR REHABILITATIV� CONSTRUCTION equal to more than 5% of <br />current assessed market improvement value of specified building' <br />'NOTE: Submission o( design documents per RCW 64.55.020 and independent inspection per RCW 64.55.060 <br />All building enclosure design documents lo be stamped and signed by a Washington Slate Architecl. The <br />ducuments should also contain a stamped signed stalement by the same architect or engineer who has slamped all <br />b�ilding en�losure documents that "the undersigned has provided building enclosure documents that in my <br />professional judc�ment are appropriate to satisfy the requirements or RCW 64.55.005 through 64.55.090". <br />Final inspeclion or'CeRificate o( Occupancy' cannot be issued unlil receipt of a signed letler from an independenl <br />inspector certi(ying �hal ihe building enclosure has been inspected during the course of construclior and has been <br />conslrucled in substantial compliance with the building enclosure des�gn documenls. <br />RECORDED COVENANT OF SALE from Snohomish County' <br />'NOTE: Sale Prohibitiun Covenanl per RCW 64.55.010 <br />Submil site plan with location of buiiding, permil with descriplion of work and certified copy of recorded c� �enant <br />(rom the real property records o( Snohomish County, Washington for specified building. <br />CONVERSION to condominium" <br />'NOTE: Permils may be required based on inspection results. <br />Undersigned will compty wilh owner indeper�denl inspection alternative per RCW 64.55.090 and RCW 64.34.400(2). <br />_ ------- . --- — ----- ---�--- — ------ <br />Signalure of Owner or Aulhorized Agenl Printed name o( Owner or Au(horized AgCnl Phone # Dato <br />'i� <br />� <br />a <br />_ ..._. _--'--- �----. _.._. _— -- _ .. . _ ---- -- - <br />Printed name of 6usiness Address <br />4 <br />chklsl-ncw �n and condo (rev 4121/OB) <br />-- �---- �—�----.__.._---- <br />City Zip Code <br />fOR OFFICE USE ONL � <br />