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_ RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET,lifital <br /> 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 COVENANT OR CONVERSION <br /> CHECK ALPINE HEIGHTS <br /> 1901-78TH PL SE SE EVERETT 98204 LOT 19 <br /> ONE <br /> nM.;.� w,.. .. ,.�.�.:_�.�..„ .. ,....��_u..-_ .....r:.. ,..,,r_. .-._ -._-. . _,..Y..._ w..._. r _:....:,.. _._.0 »�., <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 1(C)ASSESSED BUILDING VALUE J(D)DlyIDE(B)by(C)_-%Q <br /> ❑ NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to more than 5% of <br /> current assessed market improvement value of 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 /> 0 RECORDED 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 /> ft TOWNHOMES ON SINGLE PLATTED LOTS* <br /> *NOTE:This exemption allows the applicant to submit for building permit white 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 r. k involy-6 to apply for a single platted lot exemption to RCW 64.55 for each unit of this townhome building. <br /> r <br /> 4 <br /> i 4 STEVE SNYDER 425-319-0122 4-5-16 <br /> Signature of Own: or Authorized Agent Printed name of Owner or Authorized Agent Phone# Date <br /> ALPINE HEIGHTS LLC 120-SW EVERETT MALL WAY SUITE 100 EVERETT 98204 <br /> Printed name of Business Address City zip Code <br /> 4 <br /> chklst--new corn and condo(rev 10/15) FOR OFFICE USE ONLY <br />