3006 15TH ST 2024-12-09 - Laserfiche WebLink

ra EVERETT ELECTRICAL PERMIT AFFIDAVIT - -l-e Exemptions: property owner, renter or lessee may purchase a permit to do an electrical installation on his/her own or qualified leased property under the mditions as described in RCW 19.28.261. racx c p w t +sr€r x eyEiK4 _c, 31t or a nanfutafi} rek Wws toga iEBUM Jrsay pwrha r an r4ecifixl°permit as descrRaed m1Z W I am applying for the property owner exemption under the following conditions: You must select the option that applies to your situation: I vva=_ar under penalry of perjum, that: l :mn a: reg stered ere" amtractar vrtre is vsbs*rx; a t...nVorar•} efer rtc;-A sE--vice owned' by me m a.. proms where-4 ;,-im the generaf Contractor OR I swear under penalty of perjury that I am: Qf- The CWRWT 0 Mal y...r'W The renter or lessee of real property. (You must provi& 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). �{7 A single family residence THAT IS NOT intended for rent, sale, or lease AND I will be personalty doing the electrical work AND I will ViJ 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 .r £:l IM84G1.-2.3, err 44 r � rrt�al.pcz>pettf''fhat iS tnt��ehi'icr reKi :saie.:or lease AD mysmeand'W.a Mari s3 heirkeei and paid employee(s) � be doing the efecta ( work: ElA farm AND 1, 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; t 150 ice at Exusktess.1iiatis.NCIT" wtended.flornmt 5ale, rrleaseAND 1, personally, and/va regulaily >,chEduted ar {mid. empk, a -s.) vw# 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 .awurMtiar.050 L-A%tst',ma*in,anise`om'tt4-ek-knfsi;W'rera. dArs,aa'exL-et &aid .* asap&atws490&' -'W4 anOMAr��aSa�'are�A vM be polo£ med 1'y apprwxW eh, rerWied eiezLnc°i--ans cq te*fified am, , hiDam vsls rmp- sit-b*:e+-,ct compensated 1w :deal nark per P-C W 4- 1 AGREE and wish to purchase an electrical permit under the conditions described above. PERMIT # Page 3-Affidavit