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'Or <br /> R 64.55 ULTTI 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.oro <br /> REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANTOR CONVERSION <br /> CHECK /` CR.PC 9Gi,L.. ...,, //fL 1R Abel/�2 ' 1 7 wA Ci c20/ . <br /> BOX Property Name - Address Building Number Permit Number <br /> I 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':i(C)ASSESSED BUILDING VALUE i(D)DIVIDE(B)by(C) <br /> i <br /> 0 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 /> 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 /> 0 TOWNHOMES ON SINGLE PLATTED LOTS* <br /> *NOTE:This exemption allows the applicant to submit for building permit while concurrently seeking to obtain unit Iot <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 riot be issued until ROW 64.55is met:: The applicant accepts <br /> the, isk, involved to,a ply fora s`;gie platted lot-.exemption to fCW 64.55,for each unit of this townhome building. <br /> 2 <br /> Signature of Owner or Authorized Agent Printed name of Owner or Authorized Agent Phone# Date <br /> Printed�ame of ud l �'� %� � � 2 .. .�»...�....��,,... <br /> Business Address City Zip Code <br /> c 4 <br /> oliklst-new coin and condo(rev 10115) FOR OFFICE USE ONLY <br /> Z1L <br />