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P°', RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET CITY OF EVERETT PERMIT SERVICES 3200 Cedar Street, Everett,WA 98201 425-257-8810 email:everettepsa©everettwa.gov website: www.everettwa.qov/permit REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION CHECK ONEt S� `VY��" IAI4 BOX Property Name Address ex„,051%4(, /Ns Building Number Permit Number O 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 the building enclosure for a multiunit residential building or mixed use project per RCW 64.55.010, which may exceed the valuation for building permit. (A)ENCLOSURE REHAB COST (B)MULTIPLY(A) BY 100 (C)ASSESSED BUILDING VALUE (D)DIVIDE(B) by(C) =% latit{gS• 11 s • - . ► D.G, ❑ NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to more than 5% of current assessed market improvement value of specified building* *NOTE: Per RCW 64.55.010, RCW 64.55.020 and RCW 64.55.060 Each building enclosure design document is to be stamped and signed by a Washington State architect. The documents should also contain a stamped signed statement by the same architect that"the undersigned has provided building enclosure documents that in my professional judgment are appropriate to satisfy the requirements or RCW 64.55.005 through 64.55.090". Final inspection or 'Certificate of Occupancy' cannot be issued by the building department prior to receipt of a signed letter from an independent inspector certifying that the building enclosure has been inspected during the course of construction and has been constructed in substantial compliance with the building enclosure design documents. O RECORDED COVENANT OF SALE from Snohomish County* *NOTE: Sale Prohibition Covenant per RCW 64.55.010 Submit site plan with location of building, permit with description of work and certified copy of recorded covenant from the real property records of Snohomish County, Washington for specified building. ❑ TOWNHOMES ON SINGLE PLATTED LOTS* *NOTE: This exemption allows the applicant to submit for building permit while concurrently seeking to obtain unit lot subdivision for each townhome. This exemption is an alternate to providing building enclosure design documents for the townhome building. Certificate of Occupancy will not be issued until RCW 64.55 is met. The applicant accepts the risk involved to apply for a single platted lot exemption to RCW 64.55 for each unit of this townhome building. C.at _ s 6 — • 3 21 Signature of Owner or Authorized Agent Printed name of Owner or Authorize. Agent Phone# Date NAP anN4 tetztsi i 7e t$fVt six) t,lNNwa>t 0 tOs- etsaerl Printed name of Business Address City Zip Code 2 Chklst2015-RCW 64_55(rev 8/16)