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i p p EL TRICAL`PE MIT AFFIDA 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. 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: I 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 penalty of perjury that I am: ErThe 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 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: in 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 completion of the 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 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 work. ErAn 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 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; 111 An EXISTING place of business AND I, personally, and/or a regularly scheduled and paid employee(s)will be doing the electrical work; 1-1 employee(s) NEW place of business that is NOT intended for rent, sale, or lease AND I, personally, and/or a regularly scheduled and paid employees)will be doing the electrical work; or ❑ 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 will be performed by appropriately certified electricians or certified and supervised trainees who are volunteering and not being compensated for electrical work per RCW 19.28.091(7). ©I AGREE and wish to purchase an electrical permit under the conditions described above. ct Owner Name(Print) I.,-.1-pri4iM4 (2,_ S 7/ , /1,„'1/1, Owner Signature Date PERMIT# Page 3-Affidavit