402 ROCKEFELLER AVE 2021-08-27 - Laserfiche WebLink

• >Y � v 5� � srt 4py�,�` t �i � - 1 c � s fYi� {fib kt}f i-tt 4 ti l A'YSSZ 1 i y r t y i S< Y l - �_ K �, , k f 3 � St : Cq ✓ �t t t �T � 3� �^': Veit.:- � vL., 4 is.,.,>:.YVx ..L ,l 1 �. S1 a•. t tx� .i Yr �kr �{ t bi: 4��b,5:V ? ,_ ag,gi*;t s zi.:.Yx 1 tuF r Y S i 4 s; e NG r ..'� a 1 , r x t >�_40,E 4,, , , t, E ECTI �l ► P ;F I tp"17 D 11/1Y [ .rf 3itn �s r,l f 1 ..: �� 44fj..A. (�.11 Y7r�fY33� 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 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 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: The owner of real property;or ri 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($30,000.00). 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; • 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; 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 lease AND I,personally, and/or a regularly scheduled and paid employee(s) will be doing the electrical work;or nOther property that is NOT intended for rent,sale,or lease AND I,personally,and/or a regularly scheduled and paid employee(s0 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 ri 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). n I AGREE and wish to purchase an electrical permit under the conditions described above. MELANIE MENDENHALL Owner Name(Print) • Owner Signature Date PERMIT# Page 3-Affidavit