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RCW 64.55 �riULTI-FAMILY CERTIFICA . iON WORKSHEET <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Slreet, Everett,WA 98201 <br /> 425-257-9810-FAX 425-257-8857-www.everetlwa.ora <br /> REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION <br /> ONE N ���'----�-�=�a-Q�1_��'.-1_L�rI� �. l� �'��:'�I C�r� - (7:�l'-I- <br /> BO% Property Name ddress D Buildi Number � Permit Number <br /> � REHABILITATIVE CONSTRUCTION equal to or less than 5% or Iess of current assessed <br /> market improvement value of specifled buflding• <br /> 'NOTE Applicant to provide eMire cost of rehabilitative construction to the building enclosure for a multlunit <br /> residential building or mized use p�oject per RCW 64.55.010, which may exceed the valualfon for building permit. <br /> (AJ ENCLOSURE REHAB COST,(BJ MULTIPLY(A)BY 100� (CJ ASSESSED BUILDING VALUE �(DJ DIVIDE (B)by{C) =°/a <br /> � �JOU � UII � OVo J� � I '1 " `i ( O <br /> ❑ NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to more than b% of <br /> current assessed market improvement value of specified buflding' <br /> 'NOTE Per RCW 64.55.010, RCW 64.55.020 and RCW 64.55.060 <br /> Each building enclosure design document is to be slamped and signed by a Washington State architect. The <br /> documents should also contain a slamped signed statemenl by fhe sama architect that"the undersigned has <br /> provided building enclosure documenls thal in my protessional judgment are appropriate to satisfy the requirements <br /> or RCW 64 55 005 through 64 55 090". <br /> I Final inspection or 'Certificale of Occupancy' cannot be issuad by the building department prior lo receipl ot a <br /> signed letter from an independent inspector certifying ihat th� building enclosure has been inspected during the <br /> course of construction and has been constructed in substantial compliance with the building enclosure design <br /> documents <br /> ❑ RECORDED COVENANT OF SALE from Snohomish County• <br /> 'NOTE Sale Prohibition Covenant per RCW 64.55 010 <br /> SubmR sde plan with localion oi building, permit with description of work and certified copy of rewrded covenant <br /> Irom the real property records of Snohomish County,Washington for specified building. <br /> ❑ GUNVERSION to condominfum' <br /> 'NOl E permits may be reqwred by the City of Everett pei the results oi the Independent insp�ction reoort <br /> Undersigned will comply wdh owner independent inspection alternatwe per RCW 64 55A90 and RCW 64.34 400�2). <br /> _ _ _ __-- --- --- - ------- -- <br /> Slgnature o/Owner or Authorl:ed Agent Printed nams olOwner or Authorl:ed Agent Phona N Dat� <br /> Printed name ol Business Address Clty Zip Code <br /> chklst-now com and�n�do!rev 4f77/OP) FOR OfFICE USE ONLV <br />