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l`2,emie0::400 rk` sky tk.. �'\ �v <br /> llair�����''``�,� ,� ; �v�� a 3 � ��� � � � f��� �- <br /> x s xk `"` .:d x'�i�,c � �, k; 1: 0� .-wA- ;ww ftt ��xz `\s`\c <br /> "^7tf�, � g.x j k ,,� {...�� 5 .,...�x E :.s \.} .,,' v,,.,.3�..`}�,� �,�?ss..� x,� ���+i4zs�1'��xam�s �`\�`�'�\a nx\r w "� �...x.S ‘. <br /> t s Ato 5 ""v i �r/� ;i �' '�; a: .l�` $'Yi3: f' ``\ �'*a ''F'�,a.i k**I v��� � e, y t_. <br /> `, ��.x �' �� /R .. �� .ta:. a?., S.,.r,� t t'� ,4`v liS�. ,AY``?.k\ <br /> : ,� ; ..:��'� ��� k����,55z x\ s�� 'v+::e .. . ...s. w�ki°.s��s,t.�'�kx�"�,�`��3�..i'�x e� �,. '.a � ,�;, >�r.x'�v��,� v:, <br /> fit' \`" 4 �., .. Y` 1� '\z'z. }`� C^u�Y l A , Y", <br /> � � x'` c' - �� t�� � ♦ �xxsr` �,� i�'x �k� ' w k z ���x�a�s s\?�. � � M x�; �..� <br /> �.�::;.;�., ... z a �� C �.+ .a.\:`:x-,.«'��z �a.2� .�k^�,.�:..�\_ ._.,��`.��,���1. x�'i1.n�,F<-c,`s� '� x'a:�.�``'���.?a.�4�c"''�.. X ��. ,:..:�... ......#���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 /> O The owner of real property;or <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 /> ❑ <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 /> ❑ 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 /> O A farm AND I,personally,and/or a regularly scheduled and paid employee(s)will be doing the electrical work; <br /> 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 /> ❑ <br /> 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 /> ❑ organization and the total market value of the electrical work does not exceed tt irty thousand dollars($30,000.00),and th electrical work will <br /> be performed by appropriately certified electricians or certified and supervised trainees who are volunteering and not being compensated for <br /> electrical work per RCW 19.28.091(7). <br /> 0 I AGREE and wish to purchase an electrical permit under the conditions described above. <br /> Owner Name(Print) <br /> Owner Signature Date <br /> PERMIT# Page 3 of 3 <br />