2221 COLBY AVE 2025-03-27 - Laserfiche WebLink

EVERETT ELECTRICAL PERMIT AFFIDAVIT Code Exemptions: A property owner, renter or leecpt> may pixl havr+ n 1'wrmll to do an olecirlcal Installation on his/her own or qualified leased property under the conditions as described in RC.W IQ 28 261 A nonprofit corporation with euxlgrlt tax exerllpl status o1 n nonprofit religious organlzation may purchase an electrical permit as described in RCW 19 28 091(') I am applying for the property owner exemption tinder the following conditions: Tou must Select the option that applies to your situation: I wAw uxier gutty of penury /hat D1 am a reatslerd general contractor who iS InS1A111119 A temporary electrical service owned by me on a project where I am the general conbvckx KJ I sulaw under penMy of perjury flat I am The owner of real property: or ❑The renter or lessm of real property (You must provide a signed letter from the owner of the property granting permission for you as the tenant to parlorm electncal work on the property), or aA nonprnft 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 rvu must sorted un option tnat applies to your situation: ❑A svV* tarr*l residence THAT IS NOT intended for rent, sale, or lease AND I will be personally doing the electrical work AND I will 0=41y SW 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 empoyee(s) fill be dong 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) vA be doing the electrical work, 0 A tam: AND 1, personally, and/or a regularly scheduled and paid employee(s) will be doing the electrical work; 0 An EXISTNG place of business AND I, personally, and/or a regularly scheduled and paid employee(s) will be doing the electrical work; QA NEW place or business that is NOT intended for rent, sale, or lease AND I, personally, and/or a regularly scheduled and paid empioyeelsf 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 0 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. PERM/T0 G J 5 dOC `/bn Page 3-Affidavit