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ELECTRICAL PERMITAI= DAVIT <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 /> 1 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 /> 0 The owner of real property;or <br /> EiThe renter or lessee of real property. (You must provide a signed letter frorn the owner of the property granting permission for you as the <br /> tenant to perform electrical work on the property);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 /> 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 /> VA 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 /> , 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 /> ❑ 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 <br /> employee(s)will be doing the electrical work; <br /> A farm AND I, personally, and/or a regularly scheduled and paid employee(s)will be doing the electrical work; <br /> An EXISTING place of business AND I, personally,and/or a regularly scheduled and paid employee(s)will be doing the electrical work; <br /> ❑ 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) <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 ecempt status as provided under 26 U.S.C.Sec.501(c)(3)or a nonprofit religious <br /> ❑ 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 /> M 4 <br /> oris br6k� <br /> Owner Name(Print) <br /> ( <br /> (Avl/,� <br /> Owner ftnature Date � <br /> PERMIT# E(- `'�/0-004age 3-Afftdavlt <br />