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EVERETT ELECTRICAL PERMIT AFFIDAVIT <br />WAiNINYTON <br />Code Exemptions: <br />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 />nditions 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 />I am applying for the property owner exemption under the following conditions: <br />rou 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 />❑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 <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 />r ou must select the option tnat applies to your situation: <br />My 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 <br />1=4 occupy 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 <br />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 <br />paid 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 />ri 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 <br />employee(s) 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(s) will be <br />doing the electrical work. <br />I am 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 market value of the electrical work does not exceed thirty thousand dollars ($30,000.00), and the electrical work <br />will be performed by appropriately certified electricians or certified and supervised trainees who are volunteering and not being <br />compensated for electrical work per RCW 19.28.091(7). <br />0 1 AGREE and wish to purchase an electrical permit under the conditions described above. <br />Tt !?4'L 4-1) 6r�'46T4 <br />Owner Name (Print) <br />Owner <br />I 6 <br />Date <br />PERMIT # Page 3-Affidavit <br />