10817 HOLLY DR 2021-12-22 - Laserfiche WebLink

• e 4. ________ _ ____ __________,.____T____ ._=,1 . • . . , , , ELECTRICAL PERMIT AFFIDAVIT 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 ® 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; 0 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 ® 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 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 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). ® I AGREE and wish to purchase an electrical permit under the conditions described above. Owner Name(Print) Owner Signature Date PERMIT# , Page 3-Affidavit i