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aor <br /> EVERETT ELECTRICAL PERMIT AFFIDAVIT <br /> wain-.i+uie,,, <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 19.28.261 <br /> A nonprofit corporation with current tax exempt status or a nonprofit religious organization may purchase an electrical permit as described in RCW • <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 /> 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 /> ri The owner of real property;or <br /> n The rental o,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 p:openly),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 /> tea 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 /> 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 /> 1-1 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 /> nAn 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 /> ElA farm AND I,personally,and/or a regularly scheduled and paid employee(s)will be doing the electrical work; <br /> Li An EXISTING place of business AND I,personally,and/or a regularly scheduled and paid employee(s)will be doing the electrical work; <br /> rejA 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 /> • doing the electrical work. <br /> I am 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 /> rat 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 /> I AGREE and wish to purchase an electrical permit under the conditions described above. <br /> Owner Name(Print) <br /> Owner Signature n€fhr <br /> PERMIT# Page 3•Affidavit <br />