2227 WETMORE AVE 2023-10-17 - Laserfiche WebLink

Mill r: ■s EVERETT ELECTRICAL PERMIT AFFIDAVIT MA9H1NCT0N I Code Exemptions: I 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 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: It swear under penalty of perjury that: I am a registered general contractor who is installinq a temporary electrical service owned by me on a project where I am the general I contractor C� I swear under penalty of perjury that I am: v The owner of realr p operty; or (1 The renter or lessee of real property. (You mustrovide a signed letter from the owner p 9 wn r of the property granting permission for you as the ' t--I 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, sale, or lease AND I will be personally doing the electrical work AND I will occupy the residence for at least 24 months after completi-on of the electrical work; IA 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) w„� c d ill the @ 'I '+ c + the ietli + al tr . i b doling ci Cti �.ai v✓dik AND I JViii OCCUpy Gi'ie Of the units for at least 24 mOnu,a after CO�i�picuoi� Of trio ciaCu�%a, work. An EXISTING 1, 2, 3, or 4 unit residential property that IS intended for rent, sale, or lease AND myself andior a reguiariy scheduled and I paid 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 1, personally, and/or a regularly scheduled and paid employee(s)will be doing the electrical work; I ❑ 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 I 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 doing the electrical work. 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 organization and the total market value of the electrical work does not exceed thirty thousand dollars ($30,000.00), and the electrical work I will be performed by appropriately certified electricians or certified and supervised trainees who are volunteering and not ging compensated for electrical work per RCW 19.28.091(7). I AGREE and wish to purchase an electrical permit under the conditions described above. Tim Rehberg Owner Name (Print) 01/26/2023 Owner S' ature Date PERMIT" Page 3-Affidavit