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

PQM IT' FODl�1i�T Code Exemptions: A property owner,renter or lessee may purchase a permit 10 do an elecUlcai installation on his/her own or qualified leased properly 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 19.28.091(7). I am applying for the property owner exemption under the following conditions: You must select the option that applies to your situation: 1 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 penally 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 The L t 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.601(o)(3)or a nonprofit religious organization,and the total value of the electrical work does not exceed thirty thousand dollars($30,000.00). AND you must select the option that applies to your situation: E] A single family residence THAT IS NOT Intended for rent,sate,or lease AND I will be personally doing the electrical work AND i will occupy the residence for at least 24 months after completion of 1119 electrical work; ❑ A NEW 2,3,or 4 unit residential property that IS Intended for rent,sale,or lease AND myself and/or a regularly scheduled and paid emptoyoe(s)will be doing the electrical work AND I will occupy ono of the units for at toast 24 months after completion of the electrical work. An EXISTING 1,2,3,or 4 unit residential properly that 13 intended for rent,sate,or lease AND myself and/or a regularly scheduled and paid El employee($)Wil be doing the electrical work; ❑ A farm AND 1,personally,andfor a regularly scheduled and paid emptoyea(s)Will be doing the electrical work; ❑ An EXISTING place of business AND I,personalty,and/or a regularly scheduled and paid employee(s)will be doing the electrical work; A NEW place of business that is NOT Intended for rent,sate,or lease AND 1,personally,andfor a regularly scheduled and paid employees) ❑ will be doing the electrical work;or Other properly that Is NOT Intended for rent,sale,or lease AND 1,parsonaty,and/or a regularly scheduled and paid employeo(sD will be ❑ doing the electrical work. am a nonprofit corporation that holds a current tax ecompt status as provided under 26 U.S.C.Soo.601(0)(3)or a nonprofit religious E] organization and the total market value of the electrical work does not exceed thirty thousand dollars($30,000.00),and III electrical work will be performed by appropriately certified electricians or certified and supervised trainees who are volunteering and not being componsoled for electrical work per ROW 19.28.091(7). t AGREE and wish to purchase an electrical permit under the conditions described above. 41 ' AZL LUA lid Owner Name(PrIM) Owner Signature Date PERMIT ft Page 3�Algdavlt