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1 J � � <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—www.everettwa.orq <br /> REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED CC)VENANT OR CONVERS[ON <br /> CONEK Riverfront - Eclipse 3304 31 st Dr., Everett, WA, 98201 1 C/(p(� -c�7c�' <br /> BOX Property Name Address Building Number Permit Number <br /> ❑ REHABILITATIVE CONSTRUCTION equal to or less than 5% or less of current assessed <br /> market improvement value 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 /> (A)ENCLOSURE REHAB COST (B)MULTIPLY(A)BY 100 (C)ASSESSED BUILDING VALUE (D)DIVIDE(B)by(C) _% <br /> ❑ NEW Ct?NSTRUCTI�N C�R REHAB[LITATlVE CONSTRUCTION equal to mare than 5% of <br /> current assessed market irnprovement value af specified 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 /> � RECURDED 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 /> ❑ T�WNHOMES UN SINGLE PLATTED LOTS* <br /> "NOTE: This exemption allows the applicant to submit for building permit while concurrently seeking to obtain unit lot <br /> subdivision for each townhome. This exemption is an alternate to providing building enclosure design documents for <br /> the townhome building. Certificate of Occupancy will not be issued until RCW 64.55 is met. The applicant accepts <br /> the risk involved to apply for a single platted lot exemption to RCW 64.55 for each unit of this townhome building. <br /> Q-2A-n- �- �Gl-n-i� Alan D Pani (425) 586-7700 02/26/16 <br /> Signature of Owner or Authorized Agent Printed name of Owner or Authorized Agent Phone# Date <br /> Polygon WLH, LLC 11624 SE 5th St., Ste 100 Bellevue 98005 <br /> Printed name of Business Address City Zip Code <br /> 4 <br /> chklst-new co���and condo(rev ]0/15) FOR O�F10E USG ONLY <br />