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EVERETT ELECTRICAL PERMIT AFFIDAVIT <br />Cote Exemptions: <br />A pmperlyowner. mnler a Nssee may purchase a permt to do an electrical instalemon an harbor am aqu ifind leased pngerly under Me <br />conditions; as described In RCW 1529.261. <br />A mnpmft comOnvon W%currant tax exempt status a a nonmoddl lellg'Mlrs oryariaatian may Wrdwes an election! permit be described in RCW <br />1028 Dol <br />I am applying for the property owner exemption under the following conditions: <br />❑I am a registered general contractor who is meaning a temporaryekchkal Samoa Owned by new on a project whom l am Me general <br />contractor <br />OR <br />swear under penalty of perjury Nat I am: <br />�✓ The wmer of real goad: or <br />T aofralyanuslprovitle asgned kner hen Ne Duman of the pmaM9ra^IIM Peanl%IPn for yeu one Nat <br />lenmanto oxform Necvial Wait on Nat propMy(', or <br />❑A rlmpoN caanvOn NM hods a current lax exempl status as Obviated under M U.S.C. Sec. 501(c((3( of a nonacpt mlpiws <br />aanalmn, and NB arms value or Nat elaelcal we* does not aueed Nirty thousand dumb; ($30,000.O0). <br />AND <br />A Wright faMF/ meldence THAT IS NOT Intended fa lent aale, Wass ANU I will be arsonaey dollg Ins eNUncM woe ANU I WIN <br />¢Npy Me maidene for at kaz124 months aver cOmpklOn of the electrical work: <br />A NEW 2.3. Or 4 unit residential pmparty Nat IS mende0 for n nt sale, or lease AND mysH andfor a Mularty Scheduled and paid <br />❑ employee(s) will be doing Me eleclriW wank AND l will occupy are of as units for at West24 months after canplelkn Of the elMrionl <br />wak <br />An EXISTING 1, 2, 3, or 4 unit residential property Net IS Intended for rent, ale, Or Name AND myself anchor a tegulaM sctsdukd and <br />oW empkyrd(s) will be doing the NecNW work, <br />❑ A farm MID I, personally. "Ora regularly scheduled and old employa(s) will be do" Nat elllctrhal wok: <br />❑ An EXISTING pkon of badness AND 1, orsaally, manor a regularly schedukl and cold employa(s)will be doing the electrical work: <br />❑A NEW plan d 0usiness Nat is NOT Intended W rere, sake, of Mesa AND marronally, anchor a regularly scMM1tled and old <br />employa(aj will be doing Me elepNwl WOW: of <br />❑Otllx tragedy that is NOT Intended for rent. Sale. Or Wass AND 1, personally. md1of a regularly srllMUMd and ode emgOyelON be <br />doing Me ekcNal wok. <br />I am a worofll mWm40n Nat hops a current Not exempt status as provided lower 26 UZZ. Sec. Sign (c)(3) or a nonprofit religious <br />❑organization aw the lMM market value of that decvical work does ml exceed NiM INMusw ddiam(S3),OW.00), add Me madmical work <br />ON be performed by appmaialely edified al"tridam or padded and suonised "doves who are volunteering and MI being <br />Q I AGREE and wish to purchase an electrical permit under the conditions described above. <br />Jeremy Shaw <br />Sgnalvm <br />7 pew <br />pEmlma Paa3wMaax <br />