410 45TH ST SW 2016-01-01 MF Import

� -- __ _ - -------- _____ -- - --- �l'01_-D�'�- I, G� RCW 64.55 MUL i I-FAMILY CERTIFICATION WORKSHEET !i I E CITY OF EVERE7T PER{iAIT SEP.VICES I 320U CeAar Stree!. Everett.WA°E201 � 425-.^.57-8610-FAX�26?57-9957-:::�,•.:'_r�:i'_':�.r.'\.. � REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION. RECORDED COVENANT OR CONVERSION � ��CHECK rV' � ��JN�� Gc�� �NE rrzi - f��n �{io A �3, � -�15'� SrS� v�ir c piial-o � 80% Property N�me A46re55 Butltlinq Nureber Permit Number , � REHABILITATIVE CONSTRUCTION equal to or less than 5% or less of current assessed market improvement value of specified building' i �� 'NOTE�. Applicant to provide enlire cost of rehabditalive censlruclion to the building enclosure for a multiunit ' residenhal building or mixed use project per RCW 64.55.010,which may�exceed the valua6on for bwlding permil. ;I ' (AJ ENCLOSURE REhIAB COST (8)MULTIPLY(A)BY iD0 (C)ASSESSED F3UILDING ✓ALUE (D)DIVI�E(B)by(C) _ •• � �850 85ooa �337, lao p. 25 %. ❑ NEW CONSTRUCTION OR RFHABILITATIVE CONSTRUCTION eyual to more than 5% of current assessed market improvement value of specified building' � 'NOTE: Per RCW 64.SSA10,RCW 64S5A20 and RCW 64.SSA60 I� Each building enclosure design document is to be stamped and signed by a Washingron State architeci. The II I documents should also conlain a slamped signed siatement by lhe same arcnitect that'the undersigned has '� provided builtling enclosure documents that in my professional judgmeN are appropriate to salisfy the rPquirements � or RCW 64.55.005 through 64.55.09Q'. ' '' Final inspeclion or 'Certifcale of Occupancy' cannot be issued 6y lhe building department prior to receipt of a �� � signed letter irom an independent inspector certifying thal the building enclosure has been inspected during the � � co�u,e of construction and has been constructed in subslantial compliance with the building enclosure design �, documents. ❑ RECORDED COVENANT OF SALE from Snohomish County' 'NOTE: Sale Prahibition Covenant per RCW 64.55.01D '�� Submit site plan witli location of building,permit with description of work and certfed copy of recorded covenant � �� irom lhe real property records of Snohomish Counly, Washington for specified building. , ❑ CONVERSION to condominium' ' 'NOTE�. permits may he required by the City of Everett per the results of ihe intlependent inspection report. �� ' Undersigned wiil compty wdh owner independent inspecUon alternalive per RCW 64.55.090 and RCW 64.34.4170(2). �� �' Signature of O�mer or Authnnzed Agenl Pnnted�ame ot Owner or Authnnzed A9en: Phone# Date ''� i � Prnted name of E3usiness Address City <'ip Coee I . 2 cl�.F.bt-nr�a �nm and crndo i.rc� .1^_?�ORI hUR OfllCli l�tiL(1NI.1" . - . — - -- -r-.�,'� _ ^