15 SW EVERETT MALL WAY NOVEL EYES 2024-06-12

EVERETT ELECTRICAL PERMIT AFFIDAVIT WASHINGTON 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 L 9.28.0 91 (7}.}. 1 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 nr co t actor OR I swear under penalty of perjury that I am: ❑ The 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 el ctrical work on theproperty); or p e 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 . g Y ($ ) AND You must select the option that applies to your situation: F-1A 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 ofthe 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. 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 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 I, personally, and/or 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 I, personally, and/or 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 I, personally, and/or a regularly scheduled and paid employee(s) will be ❑ doingh electrical work. t ee c o 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 F] 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)_ Q1 AGREE and wish to purchase an electrical permit under the conditions described above. Owner Name (Print) Owner Signature Date PERMIT # Page 3-Affidavit