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Category 2: Sensitive information <br />AFFIDAVIT FOR OwNFRS ACTING All THE CONTRA( Trip IN I IFU UT A (,ON rRAC <br />F VFRETI <br />t:ONrRACTOR LICFNSINOPMPMPfION <br />ands le provde proledhm to tole puhuc hold unr&[whle. heudolenl hnendalky Irresponsible of to lfopary nl wormtrrs <br />laovulea lite deAnluon of a caMectof <br />111 10 document conformance to the sloe requirements <br />I am applying for the properly owner exemption under the following conditi(mW <br />I cWaar undo, penally M tfonuty <br />e 1 unaaraland Thal stale law requires construclbin to Its done try a license(] roMr4aer hnbq I 411anly for 1a aMempnon <br />e 1 am due acting ea a fAnnacl0t on trip toothily that I have flwtlan for Iona than 12 monno for life purpose of sa111n0, donwtotdng of leaamg <br />e The pfolroral cnfollwlum work IN nor hang damn with Iha Intention of In( the purpose or selling Ito lmPrnven pnP"dy whole 12 momhs or <br />d:dmplullon of auto work <br />e f.ay of fCVaf*ll omployaae will nut doing", make rawmmandellona, list Out all coda equlremonlo, or Poffnnn Work to meal cede cnmpuanre <br />e I Auto* Io armodula Ilia appltnallla I110I100110to for my project ao that life roqul(ad him" 1011a Can be performed 1 also ondco fisfln I fall <br />(anpmlfahb to, faoolving any failure to meet code ragulramonlo that may r o found Through Inapeallone. <br />e I agtm no ern properly Mann I will make cure 1 have Ilia ekloo to act as my own gonadal cunleMot, and Ilia -'Path" fau"had to roofdomali <br />Ilia work Of rout tough In end flnlah Ifadea, <br />a I aura trial I am legally and flnanrlally raaponnlhle for proposed oonofucllon activity <br />0 1 will wouply wan all applloWaa lawn, indications, building ,rave, unit Tufling regulations. <br />I ern faapOnnlbb lot vmlrytnu whether the oord(actof le property licensed Willi Ill" 01n1a of Woollington and has a (;try of Eval Ml bnAlAaaa <br />Io <br />lconoa and dldalne bit luqullad "Work" f olmlla for all Jtsc)Pllnas <br />re I boron no the property owner that I may he Wattling aanaln rights that I mlOhl o halwba have under alola taw with labor And Industries Ill Any <br />docblo" to engage all un egletalad 40111140101' to Parfo(m OOnabuchon work, <br />1 morell trial I may be held 11111116 And 00140/10 sanOUC nnsnCto risk for any Inlunba nu ltalrod by en unllcenead person or Iherr AmployeaA <br />while working on my property I Am willhInt' Acting ae en oarn'"onlreclor and am aware that my horneownor's Influence '"my not provide <br />cavarage for th000 lNurle9, <br />1 understand that A bulldmg pronlg uhtahmd by file Property owner will) fotalhae Infonnnllon to abtAln An ""in lOn provided untlar RCW <br />1h.27 000 will h* forfeited and I may be subject to civil and criminal penalties <br />ACKNOWLODGEMENT: I HAVE READ THE ENTIRETY OF THIS DOCUMENT AND CERTIFY THAT I UNDERSTAND, <br />AGREE TO THE CONDITIONS, AND WISH T'O PURCHASE A BUILDING PERMIT UNDER THE CONDITIONS <br />DESCRIBED ABOVE. <br />71�9 KZ <br />weer anra ii if <br />IO/!7/107f <br />-- 5 �30 2 o <br />Date <br />Category 2: For official use only/ disclosure permissible by law. <br />