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f � <br /> 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-�w�.everetlwa.ora <br /> REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION RECORDED COVENANT OR CONVERSION <br /> CHECK <br /> oNe /J 2�> L;j ��-S ' <br /> BOX Properly Name Address Building Number Permit Number <br /> ❑ REHA8ILITATIVE CONSTRUCTION equal to or less than 5% or le:�s of current assessed <br /> market improvement value of specified building* <br /> `NOTE� Applicant to provide entire cost of rehabilitative construction to the buildi�ig enclosure for a multiunit <br /> residential building or mixed use project per RCW 64.55.010, which may exceed the valuation for buiiding permit. <br /> __ _ _ - — —-- —,— ---- <br /> - - - _—_ -- - <br /> (AJ ENCLOSURE REHAB COST (B)MULTiPLY(A) BY 1D0 i_(CJ ASSESSED BUILDING VALUE �(D)DIVIDE(B)by(C) _% <br /> i — — <br /> �l�«� �� ��� � ���.>��l'C� <br /> ❑ NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to more than 5°/a 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 documant 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 professiona�judgment are appropriate to satisfy the requirements <br /> or RCW 64.55.005 through 64.55.090". <br /> Final inspection 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 the building enclosure has been inspected during the <br /> course of construction and has been constructed in substantial compliance with the buiiding 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 /> from the real property records of Snohomish County, Washington for specified building. <br /> ❑ CONVERSIQN 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 /> SignatureofOwnerarAuthorizedAgent PrintednameolOwnerorAuthorizedAgent Phone# Date <br /> Printed name of Business Address City Zip Code <br /> chklst-new com and condo(rev 4/23/OB) FOR OFFICE USE ONLY <br />