HomeMy WebLinkAboutOwner Affidavit - ElectricalApplying for your Electrical Permit
In Washington, only licensed electrical contractors may perform electrical work. Property owners may
apply for an exemption from these requirements by completing this application and signing the
affidavit below before beginning electrical work:
•Complete all sections & mark the applicable fee item(s) on the Fee Worksheet.
Are you doing electrical work inside a manufactured or mobile home?
____ Yes Stop! If you are doing electrical work inside the home, you will need to contact the Department
of Labor and Industries at 206.835.1000.
____ No -Continue-
Have you applied for this exemption within the past 2 years on a different property? ____
Yes Stop! You cannot apply for this exemption and you must hire a licensed electrical contractor. ____
No -Continue-
Affidavit
As authorized under RCW 19.28.261, I, hereby apply for (Printed Name of property owner, renter, or lessee)
an exemption from the electrical licensing and certification requirements of RCW 19.28 by submission of this affidavit.
Which statement describes you? (Mark only one - If none apply, you may not take out this permit)
____ I own this property.
Your name or your company’s name must be shown on the deed to the property. Real estate agents,
property management companies, relatives, etc. cannot purchase permits for the property owner.
____ I rent or lease this property.
We need a copy of your rental agreement showing you have permission to perform electrical work.
____ I am an officer for a 501(c)(3) nonprofit corporation or a nonprofit religious organization.
The total market value of electrical work must be $30,000 or less and all electrical work must be done by a non-compensated appropriately certified electrician.
Building Division | 1055 South Grady Way, 6th Floor | Renton, WA 98057 | 425-430-7200 | Website: rentonwa.gov
CITY OF RENTON
DEVELOPMENT SERVICES
OWNER AFFIDAVIT IN LIEU OF CONTRACTOR REGISTRATION-ELECTRICAL
H:\CED\Data\Forms-Templates\Self-Help Handouts\Building\2019 Forms-Fillable\Owner Affidavit-Electrical.pdf Updated 1/8/19
Select your property type (Mark only one - If none apply, you may not take out this permit)
____ New single family residence that is not intended for rent, sale, or lease where I will be living for at
least 24 months after completing electrical work. I will be personally doing the electrical work.
____ New 2, 3, or 4 unit residential building, owned by me, that is intended for rent, sale, or lease. I will
be living in one of the units for at least 24 months after completing electrical work. I, personally, and/or a
regularly employed employee(s) will be doing the electrical work.
____ New place of business, farm or other property: Any new structure that is not intended for rent,
sale, or lease. I, personally, and/or a regularly employed employee(s) will be doing the electrical work.
____ Existing residential property, place of business or farm. I, personally, and/or a regularly employed
employee(s) will be doing the electrical work.
____ 501(c)(3) or nonprofit religious organization owned property: The total market value of electrical
work must be $30,000 or less and all electrical work will be performed by appropriately certified
electricians or certified and properly supervised trainees who are volunteering and not being compensated
for electrical work per RCW 19.28.091(7).
Your signature is required below
I believe I should be exempt from the requirements to obtain an electrical license or use a certified
electrician as provided under RCW 19.28.261.
By signing below, I certify the information I am providing on this affidavit is true and accurate. I understand
that if I make false statements or misrepresentations I may be assessed penalties.
Printed Name _________________________________________________ Date_____/_____/_____
Signature of Property Owner, Renter, or Lessee ________________________________________________
Property owner and inspection site information
Property Owner’s Name (Last, First) or Company Name
Daytime Phone___________________________ Email Address _______________________________
Mailing Address __________________________ City________________ State ________ Zip___________
Inspection Site Address
If different _______________________________ City_______________ State_________ Zip___________
Brief Description of Work being done: (Example: adding circuits in kitchen )