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esfili!P __ RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br /> 01411fria? 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 COVENANT OR CONVERSION <br /> CHECK <br /> ONE 1 � ,F��CG,��:..:,..m.�m.,:..a,,�.:,�,_..:�. ....:, <br /> Al <br /> a03 C_- 5`/-0_5 <br /> BOX Property <br /> 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 I(C)ASSESSED BUILDING VALUE I(D)DIVIDE(B)by(C) = <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 /> ❑ 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 /> TOWNHOMES ON 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 /> eC_mRcz,:e vdp etc, Lia -3l 6 Y 3 a � s-.-16 <br /> Signature of Owner or Authorized Agent Printed name of Owner or Authorized Agent Phone# Date <br /> 11 <br /> eEQ-e,-.Cit/ Gj'�'�v <br /> rt t dnameo� _ 010 54) � u.._.,.�_ �',. 6O��t.=:..m,...&.,�:.�.t,=. ..._ _._z� _.....__. ,.. ... <br /> P �.. <br /> Business Address City Zip Code <br /> cbklst-new corn and condo(rev 10/15) FOR OFFICE USE ONLY <br />