1522 PINE ST 2024-02-28 - Laserfiche WebLink

EVERETT ELECTRICAL PERMIT AFFIDAVIT uN,sOiOn Code Exemptions: 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. nonprofit corporation with current tax exempt status or a nonprofit religious organization may purchase an electrical per as described in RCW 19.28.091(7). 1 am applying to the V.operty owner e.ternption under the following conditions: You must select the opfion that apples to your situation I swear under penalty of perjury that: I am a registered general contract-or who is installing a temporary electrical seraice owned by me on a project where I am the general contractor OR I swear under penalty of perjury that t am: ® The owner of real property;or FJThe renter or lessee of real property.(You must provide a signed ietter f Kx-:the n vrier of the property granting permission for you as the tenant to perform electrical work on the property):or ElA 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($30,0(30.00)_ AND You must select the option that applies to your situation: A single family residence THAT IS NOT intended for rent,sale,or leaseAND I will be personally doing the electrical work AND I will occupy the residence for at least 24 months after completion of the electrical work; ElA NEW 2,3,or 4 unit residential property that IS intended for rent,sale,or lease AND myself and%ar a reguiarly 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 ccxflebon of the elec tical work. An EXISTING 1,2,3,or 4 unit residential property that B intended for rent,safe,or lease AND myself and/or a regularly scheduled and paid F7 employee(s)will be doing the electrical work; ElA farm AND 1,personally,and/or a regularly scheduled and€:aid employee(s)will be doing the electrical work; An EXISTING place of business AND 1,personally:andior a regularly scheduled and paid employee(s)will be doing the electrical work; A NEW place of business that is NOT intended for rent,sale,or lease AND 1,personally,andror 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 1,personally,arKlior a reegufarly scheduled and paid employee(s0 will be doing the electrical work. 1 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 th rt•thcx sai=d Mars($30,1300.00),and th electrical work will �—j be performed by appropriately certified electricians or certified and supervised tmne-es who are volunteering and not being compensated for electrical work per RCW 19.28.091(7). 1 AGREE and wish to purchase an electrical permit under the conditions described above. NORTH SOUND PROPERTIES LLC Owner Name(Print) lliul"'a Own grraEure Date E2104-193 PERW#R Page 3-Affidavit