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• • RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET "IIP/0A%FaCITY OF EVERETT PERMIT SERVICES .„44igi IT 3200 Cedar Street, Everett,WA 98201 425-257-6810 email:everettepseverettwa.gov website: www.everettwa.aov/permit REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION CHECK (� r` r ONE �� r� � C�ll� aW0 (G� { v, BOX Property Name Address Building Number Permit Number REHABILITATIVE CONSTRUCTION equal to or less than 5% or less of current assessed market improvement value of specified building* *NOTE: Applicant to provide entire cost of rehabilitative construction to the building enclosure for a multiunit residential building or mixed use project per RCW 64.55.010, which may exceed the valuation for building permit. (A)ENCLOSURE REHAB COST (B)MULTIPLY(A)BY 100 (C) ASSESSED BUILDING VALUE (D)DIVIDE(B) by(C) =% 3 D )53`?).OJ 5 . �� 90 ❑ NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to more than 5% of current assessed market improvement value of specified building* *NOTE: Per RCW 64.55.010, RCW 64.55.020 and RCW 64.55.060 Each building enclosure design document is to be stamped and signed by a Washington State architect. The documents should also contain a stamped signed statement by the same architect that"the undersigned has provided building enclosure documents that in my professional judgment are appropriate to satisfy the requirements or RCW 64.55.005 through 64.55.090". Final inspection or 'Certificate of Occupancy' cannot be issued by the building department prior to receipt of a signed letter from an independent inspector certifying that the building enclosure has been inspected during the course of construction and has been constructed in substantial compliance with the building enclosure design documents- ❑ RECORDED COVENANT OF SALE from Snohomish County* *NOTE: Sale Prohibition Covenant per RCW 64.55.010 Submit site plan with location of building, permit with description of work and certified copy of recorded covenant from th- -- property records of Snohomish County, Washington for specified building. O OWN, • O, SIN PL TIED LOTS* *NOT", is exemp in s the ap• cant to sub for bu •ing permit whi oncu ently seeking to obtain unit lot s •ivision for c wnhome. T s exam.;' n is an alte ate to pro, .'ng buildin enclosure gn d• iments forth_ • home buildin• Ce • -te of Occupa y will •e issued unti CW . 5 is met. The .plicant accepts e risk involved to . - v for a single platte• •;- emption to RCW 6 . or each unit of this town home building. \ Vr� S� Li .-3 S-`?—)cJ 3/x /0 1 Signature of Owner or Authorized A ent Printed name of Owner or Authorized Agent Phone# Date A o\A;C�YtD,q )n f A1CL.J� -� :5\4 L Prr)_6'fir) S Printed name of Busi ess Address City Zip Code 2 ChkIst2015-RCW 64_55(rev 8/16)