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t <br /> G� RCW 64.55 MULTI-FAMILY CERTIFICATION 1h'ORKSHEET <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> 425-257�8810-FAX 425�257-8857-fvww everettwa.ora <br /> VALUATION MAXIMUM, RECORDED SALE PROHIBITION, CONVERSION, OR FULL COMPLIANCE <br /> �rn2�s�t "�'� 1 30 . s�n.� ���b, o� <br /> CHECK . E V�.Q_�_ '_ <br /> .- - ...__'. .. "_"_ ___.._. <br /> _.' _ - -. <br /> ONE Cp�'1d.D(�11I11O�'1S---- ---Address � �A � Z� � Bui!ding Number Permil Number <br /> BOz Property Name <br /> ❑ vALUATION of 5% or less of current assessed value (per buflding permit application) <br /> ' Per RCW 64.55.020 (t);refer to Everett Municipal Code lor all other permit requiremenls. <br /> Calculate percentage ol valuaticn divided by current assessed value (structure only). <br /> MULTIPLY CONTRACT PRICE OF WORK BV 100 DIVIDE BY ASSESSED VALUE RESULTING PERCENTAGE <br /> ❑ RECORDED Snohomish County Sale Pruhibition Covenenant for minimum 5 years <br /> • Per RCW 64.55.010 (10); reler to Evcrett Municipal Gode lor all other permit requirements. <br /> Submit coverant recorded in the real property recoids ot Snohomish County,Washington, in satisfaclion ol lhe <br /> requirements of RCW 64.55.010 through 64.55.090. The covenant identifies the sole owner ol the propeAy <br /> described on Exhibit A (the "Property). Until termination of the covenant, no dwelling unit in or on the Property <br /> may be sold as a condominium unit except for sales listed in RCW 64.34.400(2). <br /> ❑ CONVERSION to condominium (owner inspectien alternative) <br /> ' No perrtiil required per RCW 64.55 090 and RCW 64.:i4.400(2);reler to Everett Municipol Code lor all other <br /> permit requiremenis. <br /> _ . _ _ .. _ _ . <br /> - -- - ---- - -- - _ __- - <br /> SignaWre ol Owner.r Authorited Agent Printed name ol Owner or Au�hodzed Agent Phone M ale <br /> . _ .___ .. . . ... ...... _ ._ _ _. <br /> ...___. ..-- -....._ - -- --��- - <br /> Printed name ol Business Addre�,s City Zip Code <br /> FULL COMPLIANCE with RCW 64.55.005 through 64.55.090 <br /> All building enclr,sure design documen;s to be stamped and signed by a Washington Stale Architect or <br /> Engineer, includir�g modifications to the documents Ihat become addenda or change arders to alter those <br /> documents, per HCW 64.55.010 (11). Building enclosure design documents are to contain a stamped <br /> statemenl by the architect or engineer that 'Yhe undersigned has provided building enclosure documents Ihat in <br /> my protessinnal judgment are appropriate to sat�cly lhe requirements or RCW 64.55.005 through 64.55.09J", <br /> � per RCV!64.55A20. <br /> Final inspection or Certilicale of Occupancy will not be issued wilhout a signed letter irom an Independent <br /> inspector certitying that the building encloswe has been inspecteG during Ihe course of construction and has <br /> been constructed in substantial compliance with Ihe building enclosure design documents, per RCW 64.55.060. <br /> Updated 10iO3;07 <br /> FOF OFFICE USE ONLY <br /> -___.--____— � <br /> -.—___ �/ <br /> �_�� <br />