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ELECTRICAL PERMIT AFFIDAVIT <br /> EVERETT <br /> WAMNOTOM <br /> Code Exemptions: <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 /> 1 am applying for the property owner exemption under the following conditions: <br /> You must select the option that applies to your situation: <br /> 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 under penalty of perjury that I am: <br /> The owner of real property; or <br /> ❑ The renter or lessee of real properly.(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 /> You ust 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 /> An EXISTING place of business AND 1, 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 1, personalty, 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 1,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 /> ❑ organization 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 /> I AGREE and wish to purchase an electrical permit under the conditions described above. <br /> Soi)q <br /> r) <br /> Owner Name(Print) <br /> Jf�` (' <br /> Owne Signature ate 2Ld �t�7 Z� Vt�YSU�j <br /> PERMIT# Page 3-Affidavit <br />