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EVERETT ELECTRICAL PERMIT AFFIDAVIT Code Exemptions: A property owner.renter or lessee may purchase a permit to do an electrical installation on hielhor own or qualified leased property under the conditions as described in RUN'19.28,261 A noriprof I(A:air:lotion with current tax exempt status or a nonprofit rehpious organization may pu ci tic l permit as described in ROW 19.28 091,,Ti 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 1-1 The owner of real property;or The renter or lessee of real property (You nitisi provide a signed letter from the owner of the property granting permission For you as me tenant to perforin electncal work on the properly),or A nonprofit corporation that hotels a Currant tax exempt status as provided under 26 U.S.O.Sec.501(0,3)or a nonprofit religious organizatIon and tne total value of the electmal 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; nIA NEW 3. 3,or 4 unit residential property that IS intended for rent,sato, or lease AND myself andidit a regularly schedukad and paid oMployeetst will be doing the electrical work AND I will occupy one of the units for at least 24 months after completion of the electrical wont r t 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 employee(s)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; EAn EXISTING place of business AND I,personally,and/or a regularly scheduled and paid employee(s)will be doing the electrical work; D A NEW place of business-that Is NOT interned for rent sale,or lease ANO I,personally, and/or a regularly Scheduled and paid ernrYoyee(s) will be doing'the electntal Wet*:or r 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 f1 doing the electrical work. I am a nonprofit corporation that holds a current tax ecempt status as provided under 26 U S.0 Sec. 501(c)(3)or a nonprofit religious Dorganization 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 arid supervised trainees who are volunteering and not being compensated for electrical work per ROW 19.28.091(7). I AGREE and wish to purchase an electrical permit under the conditions described above. Owner Name(Print) 12/10/2019 Owner Signature Cafe PERM/T# Page 3-Affidavit __,„—