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ti <br /> EVERETT ELECTRICAL PERMIT AFFIDAVIT <br /> Codo Exomptions: <br /> 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 <br /> conditions as descnbed 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 /> You 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 der penally of perjury that I am: <br /> 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 /> tonant to perform electrical work on the property); or <br /> LEIA 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 /> AND <br /> You must select the option that applies to your situation: <br /> 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 /> 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 /> E] 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 /> 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 /> Dorganization 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 /> di AGREE and wish to purchase an electrical permit under the conditions described above. <br /> �e � u <br /> Owner Nanta (Print) <br /> �a/lol� <br /> ner Signature Date i <br /> PERMIT S Z✓ N O 7 Page 3,Affidavit <br />