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( ' <br /> RCW 64.55 MULTI-FAMILY CERTIFICAI'ION WORKSHEET <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Street, Everelt,WA 98201 f <br /> 425-257-8810—FAX 425-257-8057—www everetlwe.ora <br /> REHABILITATIVE CONSTRUCTION NEW CONSTRUCTION, RECORDED COVENANT OR CONVER3lON <br /> CHECK ,n <br /> ONE ...V`.�'.���E.__A t�tE. uwk _ aw.��s�. c�w�_ r��Ao_..a—w----.—�_o0a4-.o3-- --__------ � <br /> BO% Property Name � � Address Building Number Permil Number <br /> C,�- 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 enlire cost of rehabilitative construction to the building enclosure for a multiunil <br /> residential building or mized use project per RCW 64 55.010, which may exceed the valuation for building permit. <br /> (A)GNCLOSURE REFIAB COST (BJ MULTIPLY(A) BY 700 (CJ ASSESSED BUILDING VALUE (D)DIVIDE(B)by(C) _% <br /> Z 1 , "� �x-� .�� ��00 c'O �j�(0 77 � vG�n �'v p , �iyO ��o <br /> ❑ NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to more than 5% of <br /> current assessed market improvement value of specified buildfng" <br /> 'NOTE: Per RCW 64 55A�0, RCW 64 55.020 and RCW 64.55 060 <br /> Each building enclosure design documenl is!o�e stamped and sign?d by a '"lashington State architecl The <br /> documenis should also confain a stamped signed statemenl by the same architect thal"the undersigned has <br /> provided bwlding enclosure documen�s that ii� my professional judgment are appropriate to salisfy Ihe requirements <br /> or RCW 64 55 005 through 64 55 090" <br /> Final inspection or 'CertiGcate of Occupancy' cannol be issued by the building deparlment prior to receipl ol a <br /> signed IeUer from an independent �nspeclor certifying that the building enclosure has been inspecled during Ihe <br /> course o( construction and has been constructed in substantial compliance wilh the buildmg enclosure design <br /> documents <br /> ❑ RECORDED COVENANT OF SALE from Snohomish County' <br /> 'NOTE Sale Prohibition Covenant pPr RCW 64 55A10 <br /> Submit sile plan with localion of building, permit with description of work and certified copy o(recorded covenant <br /> from the real property records ot Snohomish County, Washington for specified building. <br /> O CONVERSION to condominium' <br /> 'NOTE permits may be required by Ihe City of Everetl per the results of lhe independenl inspection report <br /> Undersigned will comply with owner independent inspection altemalive per RCW 64.55.090 and RCW 64.34.400(2) <br /> _ _ _ ___ - — -- -- — _. <br /> Signalur2 0l Owner or Aulhorized Agenl Printed name o(Owner or Authorized Agent Phone k Date <br /> ---- _ .__.__ .__ ..___- - �-- --- � – -------- <br /> Prinlyd name of Business Address City Zip Code <br /> 4 <br /> chhlsl-new com and condo(rev 4121i061 FOR OFFICE USE ONLY <br />