2803 COLBY AVE BOTAN RAMEN N BAR 2022-01-27

TIE��R:E - �{ 1 ode Exemptions: Property owner, renter or lessee may purchase a permit to do an electrical installation on his/her own or qualified leased property under the >nditions as described in RCW 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). I am applying for the property owner exemption under the following conditions: You must select the Option that applies to vour Sitiiiiatinn' 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 LKJ contractor OR I swear under penalty of perjury that I am: The owner of real property; or 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 tenant to perform electrical work on the property); or ❑ 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,ODO.00). AND v.. — ac C.- uru uNuon mat applies to your Situation,: El A single family residence THAT IS NOT intended for rent, sale, or lease AND I ,vill be personally doing the electrical work AND I will occupy the residence for at least 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, 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; d� An EXISTING place of business AND I, personally, and/or a regularly scheduled and paid employee(s) will be doing the electrical vtork; ❑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) will be doing the electrical work. or ®Other property that is NOT intended for rent, sale, or lease AND I, personally, and/or a regularly scheduled and paid employee(sO will be 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 �r-+ organization and the total market value of the electrical work does not exceed thirty thousand dollars ($30, DOD.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). ® I AGREE and wish to purchase an electrical permit under the conditions described above. hristina Owner Name (Print) 03-h i Date PERMIT# Page 3-Affidavit