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Ev R TT ELECTRICAL PERMIT AFFIDAVIT Coda Exemptions: A property owner, ranter 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 26.091 QI I am applying for the property owner exemption under the following conditions: 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 genera El. contractor OR I swear under penalty of pegury that I am' AThe owner of real property. or ❑j 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 inn Oppml lnal appu. L. your a A single family residence THAT IS NOT intended for rentsale. or lease AND I will be personally doing the electrical work AND I will occupy Y,, 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 rentsale, or lease AND myself anchor a regularly scheduled and paid employees) 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 elnployee(s) will be doing the electncal work. ❑ A term AND I, personally, and/or a regularly scheduled and paid employea(s) will be doing the electrical work. ❑ An EXISTING place of business AND I, personally. anchor a regularly scheduled and paid employees) 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 employees) 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 employeels0 will be doing the electrical work I am a nonprofit corporation that holds a current tax ecempt 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 th etectncal 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). ,p(I I AGREE and wish to purchaseanelectricalpermitunder the conditions described above. Oil - Owner Name (Print) 44 Y� 1 LI owner signature 9 to PERMIT a I'a9a 7.AaldaYa