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EVERETT ELECTRICAL PERMIT AFFIDAVIT WASH ING TON Co Exemptions: A prope y owner, renter or lessee may purchase a permit to do an electrical installation on his/her own or qualified leased property under e conditions s described in RCW 19.28.261. A nonprofit co oration with current tax exempt status or a nonprofit religious organization may purchase an electrical permit as desc ed in RCW 19.28.091(7). am applying for the property owner exemption under the following conditions• You must select th option that applies to your situation: I swear under penalty of per ry that: ❑ I am a registered gener contractor who is installing a temporary electrical service owned by me on a proje where I am the general contractor OR I swear under penalty of perjury that I am: El The owner of real property; or ❑ The renter or lessee of real property. (You ust provide a signed letter from the owner the property granting permission for you as the tenant to perform electrical work on the prop ty);or ❑ A nonprofit corporation that holds a current tax empt status as provided under 2 S.C. Sec. 501(c)(3)or a nonprofit religious organization, and the total value of the electrical w rk does not exceed thirty tho and dollars($30,000.00). AND You must select the option that applies to your si ation: ❑ A single family residence THAT IS NOT intended for rent, sal or lea a AND I will be personally doing the electrical work AND I will occupy the residence for at least 24 months after completion of e Iectrical work; A NEW 2, 3,or 4 unit residential property that IS intended for re , ale, or lease AND myself and/or a regularly scheduled and paid ❑ employee(s)will be doing the electrical work AND I will occup one o the units for at least 24 months after completion of the electrical work. ❑ An EXISTING 1, 2, 3, or 4 unit residential property that I intended for ren , sale, or lease AND myself and/or a regularly scheduled and paid employee(s)will be doing the electrical work; ❑ A farm AND I, personally,and/or a regularly sche led and paid employee(s)will a doing the electrical work; An EXISTING place of business AND 1, pers nally, and/or a regularly scheduled and id employee(s)will be doing the electrical work; ❑ A NEW place of business that is NOT in nded for rent,sale, or lease AND I, personally, d/or a regularly scheduled and paid employee(s)will be doing the electrica ork; or ❑ Other property that is NOT intende for rent, sale,or lease AND I, personally, and/or a regularl cheduled and paid employee(s)will be doing the electrical work. I am a nonprofit corporation t t holds a current tax exempt status as provided under 26 U.S.C. Sec. 01(c)(3)or a nonprofit religious ❑ organization and the total rket value of the electrical work does not exceed thirty thousand dollars($ 000.00), and the electrical work will be performed by app priately certified electricians or certified and supervised trainees who are volun ering and not being compensated for elect al work per RCW 19.28.091(7). ❑ I AGREE and ish to purchase an electrical permit under the conditions described above. Owne Name(Print) Owner Signature Date PERMIT# \P.g.