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ELECTRICAL,PERMITAFFIDAVIT 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 ROW 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). 1 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 genera:contractor who is installing a temporary electrical service owned by me cn a project where I am the general contractor OR I swear under penalty of perjury that I am: ElThe owner of real property;or I 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 L__ tenant to perform electrical work on the property);or —z 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!east 24 months after completion of the electrical work; 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 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. — An EXISTING 1,2,3,or4 unit residential property that IS intended for rent,sale,or lease AND myself and/or a regularly scheduled and paid -- employee(s)will be doing the electrical work; 7 A farm AND I,personally.and/or a regularly scheduled and paid employee(s)will be doing the electrical work; I 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 Tease AND I,personally,and/or a regularly scheduled and paid employee(s) will be doing the electrical work;or ET 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 lv 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 — organization and the total market value of the electrical work does not exceed thirty thousand dollars($30,000.00),and th electrical work will be performed by appropriately certified electricians or certified and supervised trainees who are volunteering and not being compensated for electrical work per RCW 19.28,091(7). 1✓1 I AGREE and wish to purchase an electrical permit under the conditions described above. MELANIE MENDENHALL Owner Name(Print) kjI/ki 11N-0,t 1- .-P t °1 1-5// 1 9 Owner Signature Date PERMIT# Page 3-Affidavit