2220 FAIRFAX AVE 2023-04-20 - Laserfiche WebLink

J. _ � .,tom ,. i � 6� ,� � • '✓.a I _, « � i%• T"y. a,` Y ' l � � EVERETT ELECTRICAL PERMIT AFFIDAVIT Mi{i1FtOTPp 6 ,. tCode Exemptions: ; A property owner, renter or lessee may purchase a permit to do an electrical installation on his/her own or qualified leaned property under ttw_ 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 des*cribed In 1928.091(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: ❑1 am a registered general contractor who is installing a temporary electrical service owned by me on a project where I am the generai 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 *'-e 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: aA single family residence THAT IS NOT intended for rent, sale, or lease AND I will be personally doing the electrical work AND ; w'.ii the residence for at least 24 months after completion of the electrical work; ElA NEW 2, 3, or 4 unit residential property that IS intended for rent, sale, or lease AND myself and/or a regularly schiedLded. 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 efecbrfeal ❑ 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 l%� 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 worir ❑A NEW place of business that is NOT intended for rent, sale, or lease AND I, personally, and/or a regularly scheduled and paid ernployelEL 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 empioyee(so o, r_ 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 aorganization and the total market value of the electrical work does not exceed thirty thousand dollars ($30,000.00), and tti be performed by appropriately certified electricians or certified and supervised trainees who are volunteering and not being eie mpentricail ate f, ,- electrical work per RCW 19.28.091(7), ng compensated , I AGREE and wish to purchase an electrical permit under the conditions described above. David Andersen vwncr ivairvtt (Frier) Date PERMIT a E210 0' 10 Page 3-Affidavit