10521 19TH AVE SE NEW LEAF PHO 2023-06-09

EvI:RE'tT ELECTRICAL PERMIT AFFIDAVIT WAWN.104 Code Exemptions: A property owner,renter or lessee may purchase a permit to do an electrical Installation on his/her own or quallfied 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 19.26.091(7). 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 0 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,sate,or tease AND I will be personally doing the electrical work AND I will occupy ❑ the residence for at feast 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; A farm AND 1,personally,and/or a regularly scheduled and paid employee(s)will be doing the electrical work; ❑ An EXISTING place of business AND 1,personally,and/or a regularly scheduled and paid employees)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,personalty,and/or a regularly scheduled and paid employee(s0 will be doing the electrical work. 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 electriclans 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