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RCW 64.55 M�LTI-FAMILY CERTIFICAI iON WORKSHEF_T <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Sireel, Everelt,WA 98201 <br /> 425-257-8810-F AX 425-257-8857-www.everettwa Qry <br /> RFHAEiLITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION <br /> _ �oqoZ'o' <br /> (:HECH� �p�.h7mvurJ <br /> oNe r�R1�kN�0(�F la�� � • catiirra_-�a�►�0-- �—� - --?°Q`10z- 304 <br /> BO% Property N�me Address Building Number Permit Number <br /> f� REHABILITATIVE CONSTRUCTION equal to or less than 5% or less of current assessed <br /> market improvement value of apecified bullding' <br /> 'NOTE Applicant to provide en6re cost of rehabilitalive construc6on to the bwtding enclosure for a multiunit <br /> residenUal building �mixe:: use project per RCW 64 55.010, which may exceed the valuation for buildmg pemut. <br /> (A)CNCLOSURC REH�[j COST (8J M1IULTIPLV(A) BV 100 ..(C)ASSESSED OUILDING VAWE ,(0)DIVIDL ([3)by(C) _ °io <br /> � �0� .��a ��C� � � 3 ; � � - - (� - � � <br /> ❑ NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to more than 5% of <br /> current assessed market improvement value of specified building' <br /> 'NOTG I'er RCW fi4 S�i 010, RCW 64 55 020 and RCW 64 55 060 <br /> Fach bud linq enr.losure design document is �o bc� slarnped and signed by a Washmglon State architect The <br /> docwnenk should also contain a stamped signed slatement by the same architect that 'the undersigned has <br /> prowded buildinq enclosure documents that in my prolessional�udgment are appropnate to sahsfy Ihe reqwrements <br /> or RCW fi4 55 006 fhrough fiA 55 090` <br /> IFinal insperhon or �Cerldicate ol Occupancy' cannot be issued by the bwldmg depariment pnor to receipl of a <br /> signed lelter (iom an inrlependent mspector ceridying that the budding enclosure has been inspected dunng ihe <br /> course of conatructinn nnd has hPen constructed m subs�anhal compliance with Ihe budding endosure design <br /> dorumenls <br /> ❑ RECORDED COVENANT OF SALE from Snohomi•,h County' <br /> 'NO1F 3a1�> I'ii�hihihon Covenanl per RCW fi4 55010 <br /> Submit site ��lan wdh location of bwlding, peirnd with descnpUon o(w�ork and cei0(ied copy of recorded c�ovenan� <br /> from the real property �ecords of Snohomish County, Washmgton (or specfied budding <br /> O CONVERSION to condominium• <br /> 'NOTE permds may be reqwred by the(,dy of Fverett per the resulls of the independent inspe�6on report <br /> Und��rsi�ned wdl comply with omner independent inspection alternatrve per RCW 64 55 090 and RCW G4 3d 400(2) <br /> SignTturc ol Ownw or Au(horized Agent Printed name ol Ownor or Autboriaod Agont Phona H Dafo <br /> � f'iin��-J n,mir ol Hic,in��ys �ddiess . . . Cily . . Zip Code <br /> chY.lsl�new com and conno�rev a129�G01 FOR OFFICE USE ONLV <br />