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RCW 64.55 MULT'I—Fa4MILY CERTIF'ICATIO(V WORKSHEET <br /> � ,� CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Street, Everett,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.orq <br /> REHABILITATIVE CONSTRUCTION, NEIiV CONSTRUCTION, RECORDED CUVENANT OR CONVERSION <br /> CONEK C ra,v��VtiecJ �en1@S. �.._._��__�...._ .�. _.���r���..�._.__.T.._.� , ._.,.___ _.� � I�" <br /> _ .,.__......__._.__._ __..,_.._ \ � ��.__��_ -___.�..,. <br /> BOX Property Name Address Building Number Permit Number <br /> ❑ REHABILITATIVE CONSTRUGTION equal to or less than 5% or less of current assessed <br /> market improvement valu� 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 permit. <br /> � . . .. . _..._� . _. _.._ _..... <br /> (AJ ENCLOSURE REHAB COST (8J MULTIPLY(A) BY 100 (C)ASSESSED BUILDING VALUE (D)DIVIDE (B) by (C) _ % <br /> _ <br /> ❑ NEW CONSTRUCTION OR REFi�BILITATiVE CONSTRUCTION eq�al ta mc�re than 5% of <br /> current assesse� marke� irnps�ov�r��n# v�lue of�pecified 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 professional 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 building enclosure design ' <br /> documents. <br /> _ _ . _ __. _ _ .. _ . _ * _.__ _ ._ _. <br /> � __ __ _ <br /> RECORDED COWENANT 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 /> ❑ GC7NVERSION 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 /> _ .. .. .. ._. .... ... ..�_ _ .. .-- -...,...... .... ... __.._. ._.._..... .. ......... ........_ ...m..,._. _�.._:g._. ,. ... ._.. ._...._... .. ,....._ ._ ._..... ,.,.. ._.. <br /> Signature of Owner or Authorized Agent Printed name of Owner or Authorized A ent Phone# Date <br /> _ _ __.. . _ .�. . .. . , _ _.. .. _ ,. . _ _ _ <br /> Printed name of Business Address City Zip Code <br /> 4 <br />