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5 t t r <br /> ELECTRICAL' PERMIT A FID A VT \ <br /> ,,, �\ a x_... ,a ................ .. a,....... .......a_.... .... .n..... ._......._... <br /> !Code Exerinptions 9 <br /> IA 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 RCW j <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: j <br /> -1-1-1 <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 /> CoptAcr <br /> The•earner of real property;or <br /> ® <br /> 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 <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 /> ® <br /> 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 /> 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 /> ® 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 /> ® A farm AND I,personally,and/or a regularly scheduled and paid employee(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 /> ® 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 /> 0- Other <br /> 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 /> -: organization 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 /> 1 I AGREE and wish to purchase an electrical permit under the conditions described above. <br /> Cii ' ©r eveee77"' <br /> Owner Name(Print) <br /> C oAv racr' 'Matz -- Sc o fl F'Gd/ivy' <br /> ogovRo---1-41:54°6 Date � <br /> COd/'TAc PERMIT# �I gO 4el l ( Page 3-Affidavit <br />