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RCW 64.55 MULTI-FAMILY CERTIFICA710N WORKSHEET <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C�dar Slreet. Everett,WA 90201 <br /> 12Ci-257-AB10-FN(425�257-8857 -www everethva ora <br /> REHABILITATIVE CONSTRUCTION, NEW CONSTRU:TION, RECORDED COVENANT OR CONVERSION <br /> CHECK ` � . .� � . ..-✓'[I/���':�'IC �'C� l�L� (°• ��' o.�;����q �l �l�.T._ � C�1�._� _�1�.�__ <br /> ONE � {7j��';r.��.. �. � ______- __ <br /> _ .__.___ ._ .._ __ _ _ . _ <br /> BOX Property Name � AdAress Building Number Permit Number <br /> ❑ REHABILITATIVE CON3TRUCTION equal to or less than 5% or less of current assessed <br /> market improvement value of specified building' <br /> 'NOTE. Applicant to provide enlire cost r habditative construc�ion to the building enclosure for a mulliunit <br /> residenual building or mixed use project ,r RCW 64 55 010, which may exceed lhe vai�ation for bwlding permit. <br /> (A)[NCLOSURE REH�O COST (BJ MULTIPLY�A) BY 100 (CJ A3SESSED BUILDING VAI UE !�DJ DIVIDE (0)by(C) _ "�a <br /> r. <br /> ,� I � �]� ,�ii ��iiJ Yr.��/", �� 5 , � ��. / .• <br /> ❑ NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to more than 5% of <br /> current assessed market improvoment valuo of specified building' <br /> 'NOTE Per RCW 64 55 010. RCW 6A 55 020 and RCW 64 55A60 <br /> Each budding enclosure design document is to be stamped and signed by a Washington State architect The <br /> documents should also contam a stamped signed statement by the same architect thal"the undersigned has <br /> provided bwlding enclosure documents ihal in my professional judgmenl are appropriale to satisfy the requirements <br /> or RCW 64 55 005 through 64 55 090" <br /> Final mspection or 'Certificate of Occupancy' cannot be issued by the bwlding department prior to receipt of a <br /> signed letler irom an mdependent mspector certifymg that the bwlding enclosure has been inspected during the <br /> r.ourse of construction and has been consiructed in substantial comphance with ihe bwlding enclosure design <br /> documenis <br /> ❑ RECORDED COVENANT OF SALE from Snohomish County' <br /> 'NOTE Salr, Prohibition Covenant per RCW 64 55 O10 <br /> � Submd site plan with location of buddmg, permd wilh descnption of work and certihed copy of recorded covenant <br /> from the real proper�y records of Snohomish County, Washmgton for speGhed building. <br /> I ❑ CONVERSION to condominium" <br /> I 'N�TE: permits may be requued by the City o( EvereU per Ihe results of the independenl inspection report <br /> � Un�lersigned will comply with owner independent inspection altemative per RCW 6 t 55 090 and RCW 64 34 400�2) <br /> x :.,��,_ <br /> I ,�. , <br /> '� , � � , _ �•v �{ (� <br /> l , {�. t ` ,' --��4=�-1 --�---L�:�L------------ <br /> j �-�--= " <br /> iSi�nn(wo of O�ncr br Authorired Agent Printed name o!Ownor or Authorixed Aganf Phona il Data <br /> �' ----- -- -- - �---�-------- <br /> � _ . . . . . Address . . . . . � .__ ---- Cily Zi Code <br /> , 1'nnled nain=ol L3us�ness n � <br /> rhw iti •�rw co�n anA condo irev 4/2J-U8� ; FOR OFFICE USE ONLY <br />