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ELECTRICAL PERMIT AFIDAV IT; IkTi EV��ETT 1 . ,f 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). 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 contractor OR 1 Vswearder penalty of perjury that I am: e owner of real property;or ❑v 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: ❑ 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. 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; �� 1 +u J"`1) �tn 1 I i�,;' 1 U n vj- 1�� 1 1 rl 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(s0 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). rl I AGREE nd wish to purchas n electrical permit under the conditions described above. &-.�rtW4 —le Own ame(Prin Owner Signature ate PERMIT# � � Page 3-Affidavit