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RCW 64.55 MULTI-FAMILY CERTiFICATION WORKSHEET <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CeAar StreeL Everett, WA 98201 <br /> 425-257�8810-FAX 425-257-8857-wm�i.evarettwa.ora <br /> REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION <br /> ' 0 <br /> CHECK <br /> oNe ncttk �'Y1�x' �"'1� lo�L �,J �1rt�_(RU_ ��.------- XO�U� • OOt <br /> BOX Property Name Address _ � �� �� Building Number Permit Number <br /> � REHABILITATIVE CONSTRUCTION equal to or less than 5°/a or leas of current asseased <br /> market improvement value of specified building" <br /> 'NOTE Applicant ro provlde entire cost of rehabilitative construction to the budding enclosure for a multwnit <br /> residential building or mixed use project per RCW 64 55A10, which may exceed the valuation for building permit. <br /> /A)ENCI.OSURF REHA[3 COST (BJ MULTIPLY(A)BV 100 (CJ ASSESSED BUILDING VALUE (OJ DIVIDE (B)by(C) =°/a <br /> �;, JC �l� -,_�; �(l( � '�� �.� - /JJ '�- �`I <br /> ❑ NEW CONSTRUCTION OR REHABILITATIVE CANSTRUCTION equal to more than 5% of <br /> current assessed market improvement value of specified building" <br /> 'NOTE Per RCW f4 55 010, RCW 64 55 020 and RCW 64 55 060 <br /> Each building enclosure design document is to be stamped and signed by a Washmgton State architect The <br /> docun-�enls should also contam a slamped signed statement by the same architect lhat`the undersigned has <br /> provided buddmg enclosure documenls that m my professional�udgment are appropriate to satisfy the requirements <br /> or RCW 64 55A05 through 64 55 090" <br /> Final i�spection or Certiticate of Uccupancy' cannot be issued by the building department prior lo receipt oi a <br /> signed letter Irom an mdependent inspector certifying that the building enclosure has been �nspected dunng the <br /> course o( constructinn and has been construc�ed in substanlial comphance with the buddmg enclosure design <br /> documents <br /> i <br /> ❑ RECORDED COVENANT OF SALE from Snohomish County' <br /> 'NOTF Sale 1'rohibihon Covenant per RCW 64 55 010 <br /> I <br /> I Submit sde p:an with localion of building, permit with descnphon o(work and certdied copy oi recorded covenanl <br /> 'I Iwm the reai property records of Snohomish County, Washinglon for specified bui�ding <br /> ❑ CONVERSION to condominium" <br /> 'NOTE permits may be required by the Gty of Everett per the results of the mdependent mspection report <br /> Undersigned wdl comp�� ti Ui owner independent inspection alternative per RCW 64 55A90 and RCW 64 34 400(2). <br /> Signaturc ol Owner or AuL rori:od Agent , Printed nanm ulOn•ner or Aufhori:ed Agenf Pbone p Date <br /> , lc� <br /> . � _ _�-. ' . r. • - <br /> � , _ <br /> . � . <br /> �^,'vi�: -�: �_ llt� � ,��_K� �n � . �;�\ i�"�/��_�Z ��C�/tG _-�L'(!�> - �-�-C t�`-�-5� <br /> 'I �inted name of 0usiness � Address Cdy U Zip Code <br /> chklsl�new cnm and condo�rev 4/2J�OA1 FOR OFFICE USE ONLY <br />