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RS�i,n„SS f 447.:,.a�}.,�il.�..fi,Xitc,�P?� 1'�'il�/7. st� �r �,�y t t, .r�s,.� �t•st,..:�1, rS!�� .,.4,..f� t�, '. ...<1,,::,��f,4�,t,,.�„/ !k. ..,ur...<,........ :�.c,�...,.:.,3t.iu.,..�,Y, r:..nit�a3.3,:.,k,l;,lS.Ca,,:.�i7fr�a#.,�i:�,�l,:.::rl�j ::1.f�..,..1 �:3,I1i.�;\1�.y�,�.1> g9} ( ����i��,.:,.. 7`�� t .1. ri ..,i.l�� � {.,,:y �,)r!,,. .h.�1 a<.:: r.:.1,,,�.t.r..,,,,,:.t'IS/��If ll��.L,.s.,�ls�...,f.r(�1�1”„4,t::ft,a::4a�k{,/(l�if��?wr,�nft�,tilltnt,,,��ixf(,cst:s,�:�!�.}��,��j„F�><,.d,::s1:,..t_1},, „�,.,,St„L.SS. �•,{{t�4 ,1}1�1 IIF t0..�{ :....<;s,}}tp:,,,,,�.,IIS,.t,,.:;:............ r,n.•fl.��?.....�/.;,,,.n.��hY.ri4I1:..1...ar�A,..u,:��;�.,,�:::;,,�4fl�i nS4.:,:lfrr:,g:,.,:;Ys�L<>.a,;. <br /> Code Exemptions: <br /> A property owner,renter or lessee may purchase a permit to do an electrical installation on his/her own or qualified leased property under the <br /> conditions as described in RCW 19.28.261. <br /> A nonprofit corporation with current tax exempt status or a nonprofit religious organization may purchase an electrical permit as described in ROW <br /> 19.28.091(7). <br /> I am applying for the property owner exemption under the following conditions: <br /> You must select the option that applies to your situation: <br /> I swear under penalty of perjury that: <br /> r7I am a registered general contractor who is installing a temporary electrical service owned by me on a project where I am the general <br /> contractor <br /> OR <br /> I swear under penalty of perjury that I am: <br /> The owner of real property;or <br /> QThe renter or lessee of real property.(You must provide a signed letter from the owner of the property granting permission for you as the <br /> tenant to perform electrical work on the property);or <br /> ❑ A nonprofit corporation that holds a current tax exempt status as provided under 26 U.S.C.Sec.501(c)(3)or a nonprofit religious <br /> organization,and the total value of the electrical work does not exceed thirty thousand dollars($30,000.00). <br /> AND <br /> You must select the option that applies to your situation: <br /> CA single family residence THAT IS NOT intended for rent,sale,or lease AND I will be personally doing the electrical work AND I will occupy <br /> the residence for at least 24 months after completion of the electrical work; <br /> n A NEW 2,3,or 4 unit residential property that IS intended for rent,sale,or lease AND myself and/or a regularly scheduled and paid <br /> employee(s)will be doing the electrical work AND I will occupy one of the units for at least 24 months after completion of the electrical work. <br /> ❑ <br /> An EXISTING 1,2,3,or 4 unit residential property that IS intended for rent,sale,or lease AND myself and/or a regularly scheduled and paid <br /> employee(s)will be doing the electrical work; <br /> CA farm AND I,personally,and/or a regularly scheduled and paid empioyee(s)will be doing the electrical work; <br /> ❑ An EXISTING place of business AND I,personally,and/or a regularly scheduled and paid employee(s)will be doing the electrical work; <br /> ❑ <br /> A NEW place of business that is NOT intended for rent,sale,or lease AND I,personally,and/or a regularly scheduled and paid employee(s) <br /> will be doing the electrical work;or <br /> — Other property that is NOT intended for rent,sale, or lease AND I,personally,and/or a regularly scheduled and paid employee(s0 will be <br /> — doing the electrical work. <br /> f am a nonprofit corporation that holds a current tax ecempt status as provided under 26 U.S.C.Sec.501(c)(3)or a nonprofit religious <br /> norganization and the total market value of the electrical work does not exceed thirty thousand dollars($30,000.00),and th electrical work will <br /> be performed by appropriately certified electricians or certified and supervised trainees who are volunteering and not being compensated for <br /> electrical work per ROW 19.28.091(7). <br /> Z AGREE and wish to purchase an electrical permit under the conditions described above. <br /> SARA HOLLAND <br /> Owner Name(Print) <br /> 7, ,'N . r `4,`5 j i <br /> Owner Signature ' Date • <br /> • PERMIT# Page 3-Affidavit <br />