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EVERETT ELECTRICAL PERMIT AFFIDAVIT <br /> Code 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 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 /> 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 /> l swear under penalty of perjury that l am. <br /> I <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 /> 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 /> AND <br /> i <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 /> ElAn 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 /> An EXISTING place of business AND 1, personally,andlor 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 /> ElOther property that is NOT intended for rent, sale, or lease AND), personally, and/or a reguJarly scheduled and pard emAaloyee(s;wjJj 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 /> vvdl 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 /> I AGREE and wish to purchase an electrical permit under the conditions described above. <br /> ,T&,C-E AI1ToNlo (AICAO SOTp <br /> Owner Name(Pfinf) <br /> \L iS u <br /> Owner Siyna ure Dale <br /> PERMIT X L Pape 3-Affid2vit <br />