2619 CEDAR ST 2019-10-31 - Laserfiche WebLink

-:111,04.;t s�'° �'t�F ;7 '`4��"4tl, iMe ! �jh«�r 21i ( � i ER ELECT`I ICALePERMII AFFIDAVIT �ERETT Code Exemptions: 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 conditions as described In RCW 19.28.261. A nonprofit corporation with current tax exempt status or a nonprofit religious organization may purchase an electrical permit as described in RCW 19.28.091(7). I am applying for the property owner exemption under the following conditions: You must select the option that applies to your situation: I swear under penalty of perjury that: ❑ I am a registered general contractor who is installing a temporary electrical service owned by me on a project where I am the general contractor OR I swear under penalty of perjury that I am: ❑ The owner of real property;or The renter or lessee of real property.(You must provide a signed letter from the owner of the property granting permission for you as the tenant to perform electrical work on the property);or 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 organization,and the total value of the electrical work does not exceed thirty thousand dollars($30,000.00). AND You must select the option that applies to your situation: — A 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 — the residence for at least 24 months after completion of the electrical work; ❑ Ae 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 employees)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. ❑ An EXISTING 1,2,3,or 4 unIt restdentlal property that IS Intended for rent,sale,or lease AND myself and/or a regularly scheduled and paid employees)will be doing the electrical work; A farm AND I,personally,and/or a regularly scheduled and paid employee(s)will be doing the electrical work; • An EXISTING place of business AND I,personally,and/or a regularly scheduled and paid employee(s)will be doing the electrical work; 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) will be doing the electrical work;or 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 IN doing the electrical work. I 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 ❑ oberganizationperformed andby the appropriately total marketcertifvalueied of elethectrielectricalciansor workrtifiedoedsand not exceedsupervised thtrainirty thousandeeswhoare dollars($30volunteeri,000.00)ngand ,not and thbeing electricalcompensated work willfor ce electrical work per RCW 19.28.091(7). I AGREE and wish to purchase an electrical permit under the conditions described above. PrYVIN S Owner Name(Print) ' v 1 Owner ign ty. (6)(AA 1ure Date PERMIT# Page 3-Affidavit