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RCW 64.55 '. JLTI-FAMILY CERTIFIC�. ,ON WORKSHEET I <br /> CITY OF �VERETT PERMIT SERVICES <br /> 3200 Cedar Streel, Everelt,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-�v,evereMwa.ota <br /> REHA9ILITATIVE CONS7RUCTION, NEW CONSTRUCTION, RECORDED CO\�ENANT OR CONVERSION <br /> CONEK �f�;c��_��- ��?��:�_rr'� R D. �` , ���� r��?� - ������-= <br /> BOX PropertyNama —�ddreas��� '-�p q��D� BuildingNumber PermftNumber <br /> I� REHABILITATIVE Cf1NSTRUCTION equal to or less than 5% or less of current assessed <br /> market improvement value of apecifled bullding' <br /> 'NOTE: Applicant to provide entire cost of rehab:'itati��e conslructiun to the building enclosure lor a multiunit <br /> residential building or mixed use project par RCW 64.',�5.010,which may exceed the valuation for building pertnil. <br /> _ _ _ _ _ . . . . - <br /> /A)ENCLOSURE REHAB COST (8J MULTIPLV(A)BY 100�(Cf ASSESSf2D BUILDING VALUE �DJ DIVIDE (0)by(C) =% <br /> � 600 � c�0 � �- 4 9d <br /> ❑ NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to more than 5% of <br /> current assessed market improvement value of spocifiod building' <br /> 'NOTE Per RCW 64.55.010, RCW 64.55.020 and RCW 64 55.060 <br /> Each building enclosure design documenl is to be stamped and signed by a Washington State architPcl. The <br /> documents should also contain a stamped signed stalemenl by the same architect that"lhe undersigned has <br /> provideJ building enclosure documents that in my professionai�udgment are appropriate to satisfy the requirements <br /> or RCW 64.55.005 through 64 55 090' <br /> Fnal inspection or 'Certificate of Occupancy' cannot be i�sued by the building department prior lo receipt ot a <br /> signed letter from an independent inspector certilying thal the building enclosure has been inspecled during the <br /> course of construction �nd has been constructed in substantial compliance with the building enclosure design <br /> documenls <br /> ❑ RECORDL=D COVENANI'OF SALE from Snohomish County" <br /> 'NOTE: Sale Prohibilion Covenant per RCW 64.55 010 <br /> Submit site plan with loca6on of building, permit with descriplion of work and certified copy of recoroed covenant <br /> from the real prouerty records ol Snohomisr Counry, Wasyington for soecified building. <br /> O CONVERSION to condominium' <br /> 'NOTE: permits may be reGuired by the City of Everetl per the results of!he independeM inspection report <br /> Undersigned wdl comply wdh owner mdependenl inspection altemalive per RCW 64.55 090 and RCW 64.34A00�2) <br /> - - ----_ - ----_ - _ ----- - — ------- <br /> Slgnetuio o/Ownar or Authorlred Agent Printed neme of Owner orAuthorizad Agcnf Phona 8 Deta <br /> PriNed nama ol Business Address City Zip Code <br /> chkls4naw wm and condo(rev 4/,23tt1A) FOR OFFICt USE ONLY <br />