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� � <br /> — — — --- - --- —; <br /> RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br /> CITY OF EVERETT PERMIT SERVICES <br /> J700 Ceda�Street. Fverelt WA 98201 <br /> 425-257-8810- f AX 425�?57-8857--�w,w eve�et?via or <br /> 1 � 3�1 �/ <br /> REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION <br /> CONEK `�/��In c 6 c ��e �ZD �� ' d Rd--D— (�I__�.l_0.►.cJ <br /> � �t� _/�_- C��---- y <br /> 80X PropB�'ty Ndmc Addre55 Bw:ding N�mber Perm4 Number <br /> f ; REHABILITATIVE CONSTRUCTION equal to or less than 5°/a or less of curre�t assessed � <br /> market improvement value of specified building' � <br /> 'NOTE Apphcant to prowde entue cost of rehabd,tahve construct�on lo the bwldmg enclosure lor a mulhund �i <br /> !es de�bal buAding or mixed use pro�ecl per RC W 64 55 010, whlch may exceed lhe va'ualion for bmld ng permit I <br /> ----- ------------ --- -- ------- -- ------ - ---- - --- --------- <br /> (A)ENCLOSURE REHAB COST�(B)MULTIPLV(A)BY 100 i(CJ ASSFSS[D dUILDING VAl U[ (0) UIVIDL(BI by(C� _% _ <br /> I � <br /> - — --- -- I' ... .... _ . ... — - <br /> �� NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to more than 5% of ii <br /> current assessed market improvement value oi specified building' �i <br /> 'NOTE Per RCW 6A 55 010, RCW o4 55 020 and RCW 64 55 060 ' <br /> IEach buildmg enciosure design document is to be sta�iped and slgned by a Washmgron State archdecl The I', <br /> documen!s should also co�lain a stamped signed statement by the same arth�tect that the undersigned has i <br /> prowded budding enclosure documents ihat m my pro�essional�udgment are appropriate to satisfy the requirements �'� <br /> or RCW 64 55 005 Ihrough 6A 55 090'�. <br /> Final inspechon or 'Certificate of Occupancy' cannot be issued by Ihe budding depariment prior to reteipt of a <br /> signed letter from an ;ndependent inspector certdymg ihal the budding enclosure has been inspected during the <br /> course of conslruction and has been const�ucted in subslantial compliance wdh the butldmg enclosure des�gn <br /> documenis <br /> f-1 RECORDED COVENANT OP SALE irom Snohomish County' <br />� 'NOTE Sa!e Prohibihon Covenant per RCW 64 55 O10 <br /> Submd sde p!an wdh locat�on ol budd�ng,permd w�U�desoipt�on ol work and certfied copy of recorded covenant <br /> from the real property reco�ds of Snohomish County,Washington for spcahed building <br /> Cl CONVERSION to condominium' <br /> 'NOT F permns m.y be requved 6y Ihe Cdy ol Everett per the results of Ihe independent�nspeclion report i <br /> Underslgned wiil comply wAh owner mdependent inspection a8emahve per RCW 64 55 090 and RCW 64 34 A00(2) <br /> S�qnatuie of Owner ur Aulhor�ted Agent Pnntetl name ol Owne�or Authonled Agenl Phone b ` Dale <br /> Pnnted name ol dus�ness � � Adtl�ess � Gty ' � Zip Code <br /> z —� <br /> .hklst�ncw cmn and cundn(rev 7/131 FUIi OFPICG USf ONLY <br /> — — — -- - �----- --- ---- <br /> - 3�3 <br />