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irt 'Mk <br /> catA <br /> � <br /> t:t a <br /> ,4.= �� _ ^chi Z �,�r ♦ 's 4��'+�"'.' 4�'Zc�. �.y 1��€�d�'hi <br /> Code Exemptions: <br /> A property owner,renter or lessee may purchase a permit to do an electrical installation on his/her own or qualified leasedroperry under the <br /> conditions as described in ROW 19.28.261. <br /> p <br /> nonprofit corporation with current tax exempt status or a nonprofit religious organization may purchase an electrical permit a <br /> 19.28.091{7}, <br /> as described in RCW <br /> I am applying for thero e <br /> p p rty owner exemption under the following conditions: <br /> You must select the option that applies to your situation, <br /> I swear under penalty of perjury that: <br /> I-3 I am a registered general contractor who is installing a temporary electrical service owned by me on a project I am the general <br /> contractor <br /> p <br /> OR <br /> I swear under penalty of perjury,that I am: <br /> D The owner of real property;or <br /> DLt 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 <br /> tenant to perform electrical work on the property);or <br /> in A nonprofit corporation that holds a current tax exempt status as provided under 26 U.S.C.Sec.501 c 3 ora nonprofit religious <br /> organization,and the total value of the electrical work does not exceed thirty thousand dollars($30,000.00). <br /> AND <br /> You must select the option that applies to your situation: <br /> n A single family residence THAT IS NOT intended for rent,sale,or lease <br /> LJ the residence for at least 24 monthsAND I will be psrsonaljj=doing the electrical work AND I will occupy <br /> after completion of the electrical work; <br /> D A NEW 2,3,or 4 unit residential property that IS intended for rent,sale,or lease AND myself and/or a <br /> 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 <br /> regularly scheduled and paid <br /> D An EXISTING 1,2,3,or4 unit residential property that IS intended for rent,sale,or lease AND myself and/or Medwork. <br /> employee(s)will be doing the electrical work; a regularly scheduled and paid <br /> 0 A farm AND I,personally,and/or a regularly scheduled and paid employee(s)will be doing the el <br /> D An EXISTING place of business AND I,personally, ectrrca!work; <br /> ofand/or a regularly scheduled and paid employee(s)will be doing the electrical work; <br /> A NEWdoingoings business work; <br /> that is NOT intended for rent sale,or lease AND I personalty,and/or a regularly <br /> o All belc the bwork;ar <br /> scheduled and paid employee(s) <br /> Other property that is NOT intended for rent,sale,or lease AND I, <br /> D doing pthe electrical work, personally,and/or a regularly scheduler{and paid em <br /> F am a nonprofit co ploYee{s0 will be <br /> #"7 I m a nonprofit <br /> tion a corporation that holds a current tax ecempt status as provided under26 t .S.C.Sec.801 c 3 or a nonprofit religious <br /> oiJ and the total market value of the electrical work does not exceed thirty thousand dollars($30,000.00),and th electrical <br /> be performed by appropriately certified electricians or certified and supervised { )( ) <br /> electrical work per ROW 19.28.091(7). Pe trainees who are volunteering and not being compensated for <br /> 0 I AGREE and wish to purchase an electrical permit under the <br /> conditions described above. <br /> Owner Atame(Print) <br /> Owner Signature <br /> Date <br /> PERMIT# <br /> Page 3 of 3 <br />