820 CADY RD BLDG J 2018-01-01 MF Import

RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET CITY OF EVERETT PERMIT SERVICES 3200 Cedar Street, Everett, WA 98201 425-257-8810-FAX 425•257-8857-www everettwe.om REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION RECORDED COVENANT OR CONVERSION _ CHECK 'n l g A ONE V`��bl� � f�lf � 0 � �� /� ItiUAO a . �goea4-_o3? BOX Properly Name � �ddress Building Number Permit Number �- REHABILITATIVE CONSTRUCTION equal to or less than 5% or less of current assessed market improvement value of specified building" 'NOTE: Applicant to provide entire cost of rehabilitative construction to ihe building enclosure tor a multiunit residential building or mixed use projecl per RCW 64,55 010, which may exceed the valuation for building permit. (A)ENCLOSURF REHAD COST (BJ MULTIPLY(A)BY 100 �. (Cf ASSESSED BUILDING VALUE (DJ DIVIDE(B)by(C) _% /UE',`�c� � �'n 1 �t�5v�n 2 ,�7S�cr�n O . 3�11 �o , ❑ NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to more than 5% of current assessed market improvement value of specified bufiding" 'NOT[ Per RCW 64.55 010, RCW 64.55.020 and RCW 64.55.060 Each building enclosure design document is to be slamped and signed by a Washinglon State archilecl The documents shou�d also conlain a stamped signed statement by the same architect lhat"the undersigned has provided building enclosure documenls that in my professionai judgmenl are appropriale to satisfy the requirements or RCW 64 55.005 through 64.55.090". Final inspection or 'Certificate o( Occupancy' cannol be is�ued by the building department prior to receipl of a signed letler from an independent inspector certifyin3 that the building enclosure has been inspected during the course ot construclion and has been constructed in sub�tantial compliance with the building enclosure design documenls ❑ RECORDED COVENANI' OF SALE from Snohomish County' 'NOTE Sale Prohibition Covenant per RCW 64.55A10 Submil sile plan with location of building, permit with description of work and certified copy of recorded covenant from Ihe real property re,ords of Snohomish County, Washington for specified building. ❑ CONVERSION to condominium" 'NOTE permits may be required by the City of Everetl per the results of the independenl inspection report. Undersigned will comply with owner independent inspection allernative per RCW 64.55.090 and RCW 64.34.400(2). SignaWre of Owner or Aulhorized Agent Prinled name o(Owner or Aulhorized Agenl Phone# Date _ _-__.. _ _ ---- -- ----- ----- _- ----- ------- — - Printed name ol�usiness Address City Zip Code Lchklsbnew com and condo Irev 4R110B1 4 FOR OFFICE USE ONLY