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Washington State Department of <br /> Property Owner <br /> Labor & Industries Electrical Work Permit Application <br /> Electrical Program <br /> www.Lni.wa.gov/Electrical <br /> Call your local AI office for more information about Electrical Permits, Fees, & Inspections. <br /> Applying for your Electrical Permit In Washington, only licensed electrical contractors may perform electrical w before <br /> III I work. P owners may apply for <br /> the affidavit belo <br /> an exemption from these requirements by completing this application and signing <br /> beginning electrical work: applicable fee item(s) on the Fee Worksheet. <br /> Complete all sections & mark the appi payment we will issue a permit valid for 1 year. <br /> After receiving your completed paperwork and pay <br /> • lso be urchased online at www.Lni.wa. ov/Licensin -Permits/Electrical/Electrical- <br /> Permits can a P <br /> Permits-Fees-and-Ins ections/Purchase-Permits-Re uest-Ins ections. <br /> s ro within cityIfmlts? <br /> Some cities perform their own inspections. If you are unsure, veri�v with the city before <br /> is thi <br /> Yes Stop! S Continue- <br /> continuing. a is not inspected by a city inspection agencyrl - <br /> I have verified that this property <br /> [] No -Continue- <br /> s you doing electrical work inside a manufactured home,bull hhe Manufactured or Mobile Home <br /> Are <br /> Yes Stop! If you are doing electrical work inside the <br /> application (F622-036-000)._ <br /> Learn more about requi <br /> re <br /> htt s://Lni.wa. ov/Licensin - ermits/manufactured-modular-mobi e- <br /> structures/manufactured-home- ermits-ins ections/ <br /> No -Continue- <br /> Affidavit <br /> Z hereby apply for an <br /> I, Helen Marie Keller <br /> As authorized under RCW 19.28.261, <br /> (Printed Name of Property owner,renter,or lessee) <br /> exemption from the electr <br /> ical licensing and certification requirements of RCW 19.28 by submission of this <br /> affidavit. <br /> YOU? Mark only one-If none apply, You may not take out this permit <br /> W Bch statement describes y ( Real estate agents, <br /> 0 1 own this property• name must be shown on the deed to the property. <br /> Your name or your company's <br /> permits for the <br /> owner. <br /> ert management companies, relatives, etc. cannot purchaseproperty <br /> prop Y <br /> rent or lease this property you have permission to perform electrical work. <br /> We need a copy of your rental agreement showing y <br /> r fora 501(c)(3) nonprofit cotrical work rporation <br /> $30,000 or less <br /> ofit religious <br /> zation <br /> lam an office <br /> and all electrical work l m st be done by a <br /> The total market value ofeleately cert►fied electrician. <br /> o <br /> non-compensated app P <br /> F500-094-000 Property Owner Electrical Work Permit Application 07-2021 <br />