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�,a.`s���'a..:. +3. ss rt" .w r s.t rdr .:kb a .lY r-' Y :� ..:F •ti5;4i•..��.IS .: ..,...ri r� :�v <br /> � ` r, . a" .�`t ; a4at ya' .� t6 o:.tr,b{'a�, ,,a,ja.•y•T:' k:.,.., y •°,.0'14 t `s as 5,t:a'<i'N• "'fie t��`{'t.. �u.t.. 5 z'�.,;ti {, ,F�. .. v <br /> '` � �r M �i s { � �gig �., f 0 K %St3G <br /> t' .w3 'ti' (.,� 1 3 ® -1,01,0m,. <br /> 4 <br /> �.zm�, a�'�tvl.:��`�,:�.It:far •3��2.,It ��iw L���e�r���'.�, �" � � �$ ��� �� Pr�' � 'sh ,5+a" <br /> Metr x h �f,.�. tg J fx � �' � `?u:�,. a,�_-s'r`i.."�`tn .. �l� .F �`�..:tk�3 cL'vi�it� F�" -.�ror E ....� <br /> et .tit}b' x Y ,'',4(t betel r' � i t6 �+,'in L'. jMI fil es, �o s�,:'y z4s'a"4`xs;�''.�Y^ Y•*#9 '7.q`.40 z d 0 �`14�.igs P �tato E�" fir s o <br /> mkuOmateaiialiklekStetaimitogrtima <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 19.28261. <br /> A nonprofit corporation with current tax exempt status or a nonprofit religious organization may purchase an electrical permit as described in RCW <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 /> ✓Q <br /> I 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 /> 0 The owner of real property;or <br /> DThe 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 /> DA 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 /> r- 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 <br /> the residence for at least 24 months after completion of the electrical work; <br /> DA 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,oro 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 /> fl A farm AND I,personally,and/or a regularly scheduled and paid employee(s)will be doing the electrical work; <br /> 0 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 /> -5,1 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 /> -Y—I doing the electrical work. <br /> 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 <br /> iIorganization 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 RCW 19.28.091(7). <br /> I I AGREE and wish to purchase an electrical permit under the conditions described above. <br /> ALISHA CL ►GSTON <br /> Owner(Verne(Print) <br /> Owner SignatureL b`to <br /> PERMIT* Page 3-Affidavit <br />