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RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Sireet, Everell,W�98201 <br /> 415-257-9910-F�X 425-257-9857-www everettwa.ora <br /> REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION <br /> CHECK �'> .� , /� ..i%�!/ C "1��14 ' [✓ C! �� -.'�i; ,L'C4 i/ y�� / r `(` �C 1,� l <br /> ONE .� {7,1'�'�',i..a�. .. i _ . . - __._--- . __c�_.!!� 1-------- l�-j-�.�- LL�1- <br /> BOX Propr.ity Name AddrPss � Bu�g Number Penni�NumY-• <br /> ❑ REHABILITATIVE CONSTRUCTION equal to or less than 5% or less of current assesaed <br /> market improvement value of specified building" <br /> 'NOTE: Appllcant to provide enlire cost of rehabilitative construrtion to lhe building enclosure for a multiunit <br /> resldential building or mixed use project per RCW 64 55 010, which may exceed lhe valuation for building permit <br /> (!I)[NCLOSURE REH�f3�OST (B)MULTIPLY �A)�Y 100 (CJ ASSESSED�UILDING VAI UE '(D)DIVIDE (B)by(C) = "/o <br /> �, i7 '7' -'' S�;/ iJ,�J �-� '7-� , �'r �-, �� ��� % �, <br /> U NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to more than 5% of <br /> current assessed market improvemont valuo of specified building' <br /> 'NOTF Per RCW 64 55 010, RCW 64 55A20 and RCW 6A 55 060 <br /> [ach buildmg enclosure design document is to be stamped and signed by a Washington State architect The <br /> documents should also contain a stamped signed statemenl by the same archdect Ihat'ihe undersigned has <br /> provided bwlding enclosure documents that m my professional judgmenl are appropriate to satisfy Ihe requirements <br /> or RCW 64 55 005 through 64 55A90" <br /> Final mspection or 'CerUfica!e ot Occupancy' cannot be issued by the bwldmg department prior to receipt o( a <br /> signed letter from an indepe�dent mspector certifying thal the bullding enciosure has been inspected dunng lhe <br /> course of construdion and nas been consiructed in substan6al comphar:;e with the bwiding enclosure design <br /> dor,uments <br /> ❑ RECORDED COVENANT OF SALE from Snohomish County' <br /> i 'NOT[ Sale Prohibition Covenanl per RCW 64 55 010 <br /> Submil site plan wdh location o( bwlding, permd wdh descnphon of work and certified copy of recorded covenanl <br /> (rom �he real p�operty records oi Snohomish County, Washington for specified bwlding <br /> ❑ CONVERSION to condominium' <br /> i 'NOTE permits may be required by the Gly ol Everett per lhe results of lhe independent inspeclion report <br /> I Undersigned will comply with owner independent inspeclion alternalive per RCW 64 55A90 and RCW 64 34.400(2) <br /> � ..:/>,. <br /> I - ` /. <br /> � � i ' �'�- . ('/�� <br /> � -. _ L s - �c1--� --�`1---'-------- <br /> iSignnG�re olOwncr br Authori:ed Agent Printed name o!Owner or Authorizod Agent Phone# Data <br /> ' - — --- <br /> -- - --- -------- <br /> II�nntcd name of f3usiness . .. Address Cdy Zip Code <br /> I <br /> chFlsl ncw rom and ronAo irev 4�23:081 ,; FOR OFFICE USE ONLY <br />