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i <br /> � RuW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br /> I CITY OF EVERETT PERMIT SERVICES <br /> � c' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> 425•257•8810-FAX 425�257�8957-www everelhva.ora <br /> VALUATION MAXIMUM, RECORDED SALE PRGHIBSTION, CONVERSION,OR FULL COMPLIANCE <br /> 'P.�IL 1 3n . S i n.a Fj � � <br /> CHECK �� �VJ�1.C�_� WA_-��Z�.__ �.'.._ � ��' O � <br /> . _ _._._.__'__'_"_._.____ <br /> ONE Cp1�1 (.YI1/�IOfY1S-----"Address � Bui�ding Number Permit Number <br /> BO% Property Name <br /> ❑ VALUATION of 5%or Iess of current assessed value (per building permit application) <br /> ' Per RCW 64.55.020 (1); refer to Everetl Municipal Code lor all other permit requirements. <br /> Calculate percentage o1 valuation divided by current assessed value(strucWre only). <br /> MULTIPIY CONTRACT PRICE OF WORK BV 100 [�IVID1=BY ASSESSED VALUE RESULTING PERCENTAGE <br /> ❑ RECORDED Snohomish County Sale Prohibition Covenenant for minimum 5 years <br /> ' Per RCW 64.55.010(10);re1:r lo EvereU Municipzl Code for all other permit requirements. <br /> Submit covenant recorded in the real property records o1 Snohomi;h County, Washing;on, fn satisfaction ol lhe <br /> requirements of RCW 64.55.010 through 64.55.090. The covenant identifies the sole owner of the property <br /> described on Exhibit A (the "Property). Unti; termination of the covenanl, no dwelling unit in or on Ihe Property <br /> may be sold as a condominium unit except for sales listed in RCW 64.34.400(2). <br /> ❑ CONVF.RSION to condominium (owner inspection altecnative) <br /> ' No permit required per RCW 64.55.090 and RCW 64.34.400(2); refer to Everetl Municipal Code lor ail other <br /> permit requirements. <br /> _ -_ __ _ . _ _ _. _ ------ ------- - - <br /> - -- - - - <br /> Signature o�Owner or Authorized Agent Printed name of Owner or Authorized Agent Phone p Dale <br /> ..--- ----_-__._ ------ --� --._. _. <br /> - -- . .. _.. _. .. <br /> _ _ - _. _ _ .---- -- —_- ---- -- Zi Code <br /> P�inted name ot Business Address City P <br /> FULL COMPLIANCF with RCW 64.55.005 through 64.55.090 <br /> All buildi�g enclosure design documenls to be stamped and signed by a Washington Slate Architect or <br /> Engineer, including moditications lo the documents that become addenda or change orders lo aller Ihose <br /> documents, per RCW 64.55.010 (11). Building enclosure design documents are to contain a etamped <br /> stntemenl by the architect or engineer lhat'Yhe undersigned has provideo building enclosure documents that in <br /> my professional judgment are appropr,ate lo satisly �he requirements or RCW 64.55.005 through 64.55.090", <br /> per RCW 64.55.020. <br /> Final inspeclion or Gertificate of Occupancy wi11 not be iss,ied without a signed letter Irom an indripondent <br /> inspector certitying that the building enclosure has heen inscected during Ihe course ol conshuction and has <br /> been constructed in substantial compliance with the building ei�ciosdre des?gn documents,per RCW 64.55.Ofi0. <br /> FOR OFFICE USE ONLY <br /> Uptlaled 10103:07 <br /> ----- -- --- - - �31�� <br />