10710 EVERGREEN WAY 2018-05-15 - Laserfiche WebLink

RC�N 54.�-WIIULTI-FAMILY CERTIFIC�JN WtJRKSHEET CITY OF EVERETT PERMIT SERVICES 3200 Cedar Street, Everett,WA 98201 425-257-8810—FAX 425-257-8857—www.everettwa.orq RE9i�1�ILiTAT9VE C06�STR�1C�"lON, NEV1/CONSTRUCTION, RECORDED COVENAiVT OR CONVERSION � ��itd` � �` rt ONE K �� G.� BOX roperty N me v" ddres - ��, i Building Number �Permit Number G j� � , REHABILITATlYE CONSTRl1CTfON equal to or less than 5°/O or less of currer�t assessed naark�t irnproerernent eralu� of specified building* *NOTE: Applicant to provide entire cost af 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 buiiding permit. (A)ENCLOSURE REHAB COST;(B)MULTIPLY(A)BY 100 ;(C)ASSESSED BUILDING VALUE '(D)DIVIDE(B}by(C) _% � �� i / ��'� o�r �� -7` �� � IVEV!/CONSTRUCTlON �R REFIA�9L.ITATf9lE CONSTRUCTIOP! �qua6 to more thar� 5% o# current asses��d marlcet improv�ment value of specified building* *NOTE: Per RCW 64.55.010, RCW 64.55.020 and RCW 64.55.060 Each building enc(asure design document is to be stamped and signed by a Washington State architect.The documents should a(so 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 ietter from an independent inspector certifying that the building enclosure has been inspected during the course of construction and has been constructed in substantia! compliance with the building enclosure design documents. ❑ RECORDED C�VENA�VT 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 the real property records of Snohomish County,Washington for specified building. ❑ TODUN�lOMES 06V SIMC��.E PLATTED LOTS* *NOTE:This exemption allows the applicant to submit for building permit while concurrently seeking to obtain unit lot subdivision for each townhome. This exemption is an alternate to providing building enclosure design documents for the townhome building. Certificate of Occupancy will not be issued until RCW 64.55 is met. The applicant accepts the risk involved to apply for a single platted lot exemption to RCW 64.55 for each unit of this townhome building. Signature of Owner or Authorized Agent Printed name of Owner or Authorized Agent Phone# Date Printed name of Business � Address City Zip Code 4 chklst-new com and condo(rev 10/15) FOR OF'FICE USE ONLY