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OP ELECTRICAL PERMIT AFFIDAVIT Code Exemptions: A property owner,renter or lessee may purchase a pent*to do an electrical installation on his/her own or qualified leased properly under the conditions as described in ROW 19.28,281. A nonprofit.eorporation with current,tax.exempt status or a nonprofit,religious organization may purchase an electrical permit as described in ROW 19.28.091(7). I arn applying for the property owner exemption under the following conditions: You must select the option that applies to your situation: I swear under penalty of perjury that: I am a registered general contractor who is installing a temporary electrical service owned by me on a project where I am the general ._ contractor OR I swear under penalty of perjury that I am: El The owner of real property;or D The renter or'lessee of real property.(You must provide a signed letter from the owner of the PraPertY granting pereliSSien fpr you as the tenant to perform electrital work on the property);or r--i A noriprofit corporation that holds a current tax exempt status as provided under 26 U.S.O,,Sec.601(c)(3)or a nonprofit religious I—I organization,and the total value of the electrical work does not exceed thirty thousand dollars($30,000.00). AND You must select the option that applies to your situation: 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 the residence for at least 24 months after completion of the electrical work; , r_I A NEW 2,3,orA unit residential property that IS intended for rent,sale,or lease AND myself and/or a regularly scheduled and paid 1---1 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. D An EXISTING 1,2,3,or 4 unit residential property Mat IS intended for rent,sale,or lease AND myself and/ore regularly Scheduled and Paid employee(s)will be doing the electrical work; El A farm AND I,personally,and/or a regularly scheduled and paid employee(s)will be doingthe electrical work; El An EXISTING place of business AND I,personally,andior a regularly scheduled and paid employee(s)will be doing the electrical work; ri ANEW place of business that is NOT intended for rent,sale,or lease AND I,personally,and/or a regularly scheduled and paid employee(s)1—I will be doing the electricat work;or f--i Other property that is NOT intended for rent,sale,or lease AND I,personally,and/or a regularly scheduled and paid ettiployee(s0 will be I—I doing the electrical work. I am a nonprofit corporation that holds a current tax ecempt status as provided under 26 LIS.C.Sec.501(c)(3)or a nonprofit religious flr—/ organization endthetotal market value of the electrical work does not exceed thirty thousand dollars($30,000.00),and th electrical work will be performed by aPpropriately Certified electricians or certified and supervised trainees who are volunteering and not being compensated for electrical work per FICW 19,28,091(7). fl I AGREE and wish to purchase an electrical permit under the conditions described above. Kaulie Vang -Contractor Greenwood Heating &AC 0wner/0in°(Print) /e1 ------ 12/271201a 'f)wrt Signature Date PERMIT* Page 3...Affidavit 0