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� � <br /> _ _- - - - -- - -- - -- - -� <br /> �I �i�i� RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET � <br /> , �„/�'�,�� CITY OF EVERETT PERMIT SERVICES <br /> " �700 .:caar Strzet Fvcrett l:'A �82�1 <br /> � .25�:57-8910- Flk 475-7�7.q957 -v:v:�_e_��:_i�'_�; nrg <br /> � � - 3 `'` -� <br /> I REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED CCVENANT OR CONVERSION � <br /> Il�ceoxK 1�oale yNa��e��.����� �o�c2 ne�5r? - _ r '.'I`I - . 'Cd--- �-� � . . ; _ �il!-t.l1-DD7 �i <br /> _ _. ��- <br /> OuJC^ N�'i'6�r Permit N��^�bCr <br /> I � REHABILITATIVE CONSTRUCTION equal to or less than 5'% or less of curr:nt assessed <br /> j market improvement valuc o(specified building' <br /> � 'NOTE Apphcant to prov�de enPre cost of rehabihtahve construcbon to the budtl�ng encWs�re f�ir a multiurnt <br /> �i residenhat bu�ldmg or mized use p�o�ed per RGW 64 55 010, v:hich ma� e�ceed the valuatw�fur buddmg permd. <br /> � (Af EIJCI.OSLRG RLHAB COST (B�FIULPPLY�P; iiY 100 (C)ASSESSED BUiI DiNG VFLUE ,'(DJ 01A9DE(B)by iC1 = <br /> (t1 NEW CONSTRUCTION OR REHABIUTATIVE CONSTRUCTION equal to more than 5% of <br /> ! current assessed market improvement value of specified building' <br /> ��i 'NOT[ Pcr RCW 6A 55 010. RCW 64 55 020 and RCW G4 55 060 <br /> '� Each bu�ld�nq erclosure des�gn document is to be star.iped ard signed by a N'ash��rglon State arch�tect 7he <br /> documents should a'�so conta�o a stamped signed statement by Ihe same arch�tect tl�at �U�e unders��gned has <br /> provided builjfig enclosure documenls that in my piofessiona!�udgment are ��ppropnate to sabsly the reqwreme�ts <br /> or RCW 64.:5 005 through 64 55 090�. <br /> IF�nal �nsped�on or 'Cern6cate of Occupancy' cannot be issued by the buiitling department prior to receip! ol a <br /> signed letter from an independent inspector certdying Ihat ihe budding enciosure has been inspetted during Die <br /> Course o( construchon and has been constructed in substanfal comp6ance w�!h the bwlding enc!osure desgn <br /> doCuments <br /> i f� RECORDED COVENANT OF SALE from Snohomish County' <br /> 'IdOTE Sale Prohib hon Coverant per RCVY G4 55 010 <br /> Submd site plan wdh locahon of bwldmg, pe�nnt r+dh descnption o!v:uik �nd ceibhed cnpy of recurde:l covenant <br /> fwm thC real property records ol5nohom�sh County VVa�hr�qto� lor spr�c�hed bw'�ding <br /> � <br /> �l CONVERSION to condominium' <br /> 'NOTE pernvts may be requ�red by the City u([verett per Ihe res�lts of Ihe independent�nspecbon report <br /> Undersigned wAI comply wltl� owner mdepenAent inspec6on alternative per RCW G4.55 090 and RCW 64 34 400Q) <br /> •_--. . ......_.._._.___--- -- -•- - ---- ._ _ ._....._ -.' - _ .._ .. . ... .._. . _ .._ .. .._. . ._.. . .. . _. ._ <br /> Signaturc o!Owncr or Author�zed Agenl Pr�ntetl name ol Owncr or Aulhorized Agen� Pnonc a Ualr <br /> . . .-.- - •-�_ .__.._ _ . . .. . ...- ._ . ----.. . .- .--.._ . ._ _._._. , .... -- •—. _. . . ._. __.. . . <br /> Pnnled name o1 dus�ness Adtlress Gdy Tip Ga�a <br /> 2 I <br /> chklst�nc�c cum and condo(rev 7/13) FOR OFFlCE- USE ONLY � <br /> . —. . _ . _—...— -- --.. .. — � - -�� ----- � — �- <br /> _ 3(3 <br />