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,W., 1.4\. ''faI fin. 3.i `t ��u`".s {:' 1' �,a Z F � t £ q 3 e"n.£styk;v?,r�\wt.., v i aa\ w�\�:i.c.., \., ixS kS q � k to '�..... ,�� a1 .Wx `.." <br /> �+ >'. V4 aC,,,'±.�a.st kr� x a...'�.a-\ tCtAt ' ?,w",Y's g: k,'F K Ts x: 1`s \ '�w.. zti X ru£�., 4 'l a. Sf a c. t <br /> a x x,, � k n a � w a <br /> t `" SXa'"`°y,x�;Z; �vt�`�i '-r, ... �_< S \ - t� V `\ a;l' Nit ) ? i s taa.;k ,P <br /> 'a 't .„a �x ,%:_-.Y. vh <1s:.... � ` x` `^'' vy a v ai tYe.'t s2 s 1�-. S`q 4:`- a 2 4i .r�... a 1 ai tek0 �`x3 a ' .z'`a- <br /> VIi <br /> . ..a aaIi ' :a ..\`.5Y-t ..y,a,:.+.> ..`���..I.:.w�,.W....IN 44 1..S H..i`s �� a Y ....e.e`y'..�.a.. A. .a,;...,'". ' >ms..,, w�.,r- x.a,..'w.. .,c., <br /> ._t.,..... .�, a s� c � s y4 Y� xb "4a �_s�,a x � 2.a y � � �i�` :.�,�..�':�:^ <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 leased property under the <br /> conditions as described in RCW 19.28.261. <br /> A nonprofit corporation with current tax exempt status or a nonprofit religious organization may purchase an electrical permit as described in RCW <br /> 19.28.091(7). <br /> I am applying for the property 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 /> ® <br /> I am a registered general contractor who is installing a temporary electrical service owned by me on a project where I am the general <br /> contractor <br /> OR <br /> I swear under penalty of perjury that I am: <br /> ►'�,The owner of real property;or <br /> ® <br /> 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 /> ® 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 <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 /> O A single family residence THAT IS NOT intended for rent,sale,or lease AND I will be personally doing the electrical work AND I will occupy <br /> the residence for at least 24 months after completion of the electrical work; <br /> ❑ A NEW 2,3,or 4 unit residential property that IS intended for rent,sale,or lease AND myself and/or a regularly scheduled and paid <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 work. <br /> ❑ 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 <br /> employee(s)will be doing the electrical work; <br /> El A farm AND I,personally,and/or a regularly scheduled and paid employee(s)will be doing the electrical work; <br /> El An EXISTING place of business AND I,personally,and/or a regularly scheduled and paid employee(s)will be doing the electrical work; <br /> A NEW place of business that is NOT intended for rent,sale,or lease AND I,personally,and/or a regularly scheduled and paid employee(s) <br /> ▪ will be doing the electrical work;or <br /> niti Other property that is NOT intended for rent,sale,or lease AND I,personally,and/or a regularly scheduled and paid employee(s0 will be <br /> doing the electrical work. <br /> 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 <br /> I-1 <br /> organization and the total market value of the electrical work does not exceed thirty thousand dollars($30,000.00),and th electrical work will <br /> be performed by appropriately certified electricians or certified and supervised trainees who are volunteeringxand not being compensated for <br /> electrical work per RCW 19.28.091(7). <br /> I AGREE and wish to purchase an electrical permit under the conditions described above. <br /> dttis t,kte ' GSL= <br /> Owner Name(Print) <br /> z/ //. <br /> Owner gnature , Date <br /> PERMIT# -Affidavit <br />