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RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Slreel, Everell, WA 96201 <br /> 425-257�0870-FAX 425-257�985i-ww�i.gy�retlwa•ora <br /> REHABIL�TATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION <br /> CHECK /� ��; (� y�... � �'7 <br /> ONE _��1L .-.�p� . - I�L�:-C[.:`2J rFJ___�_IL_- �Y�'Z7`-iLl � �l-��� L��(.'� <br /> 80X Pruperty Name Address a Building Number Permfl Number <br /> [�. REHABILITATIVE CONSTRUCTInN equal to or less than 5% or less o(current assessed <br /> market improvement value ot speciffed bullding• <br /> 'NOTE: ApplicaM ro provide entire cost of rehabilitative construction to the bwlding enclosure for a multiunil <br /> residenlial building or mized use project per RCW 64 55 010, which may exceed lhe valuation for building pertnit. <br /> , <br /> (A)[NCLOSURE RENA9 COST /B)MUL7IPLV(A) DY 700 (CJ ASSESSED�UILDING VALUE (D)DIVIDE_�B)by(C1 =_% _ <br /> � 60� � �� , 0 �0 5� �-��/ N - 4 � <br /> O NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to more than 5°� of <br /> current a3sessed market improvement value of specifled building' <br /> 'NOTE: Per RCW 64 55 010. RCW 64 55.020 and RCW 6455 O60 <br /> Each bwldmg enclosure design document is to be stamped and signed by a Washington Slole architect The <br /> documenls should also contain a stamped signed statement by the same archilect that"the undersigned has <br /> provlded building enclosure documents that in my professional judgment are appropnate to satisfy the requirements <br /> or RCW 64 55 005 through 64 55 090' <br /> Final inspectton or 'CeRiflcate of Occupancy' cannot be issued by the building department prior to receipt of a <br /> signed letter (rom an independent inspector certdyin3 that the building enclosure has been inspected during the <br /> course of ronstruct�on and has been conslructed in substantial compliance wdh the building enclosure design <br /> documents <br /> ❑ RECORDEO CnVENANT OF SALE from Snohomish County" <br /> 'NOTF Sale Prohibdion Covenant per RCW G4 55 Of0 <br /> Submit site plan wdh location of buddmg, permrt wtlh desciiption ot work and certrfied copy of recorded covenant <br /> from the real property records of Snohomish County, Washington for specified building. <br /> O CONVERSION to condominium' <br /> 'NOT[ permits may be required by the Cdy of[verett per the results of the independent inspection report. <br /> Undersigned wdl romply with owner independent inspection alternative per RCW 64 55 090 and RCW 64 34 400(2) <br /> _ _ - - ----- - -_ _— -- ----- -- --- - <br /> Signafure olOwner or Authorized A�enf Printed name olOwner or Aufbor(red AQent Phona k DaN <br /> -� � --� - - �-_ __ ---- -. . . _. _-- -. _. -- � -- - - -----`------- <br /> If'rinled n�nie ol f3usinesc Address City Zip Code <br /> � chk�st-new com and condo,�ev 4/27/O81 FOR OFFICE USE ONLY <br />