Skutt Own Exe.pdfEXEMPTION FROM CONTRACTOR
REGISTRATION VERIFICATION
FORM D
The undersigned property owner or authorized person as described below, has applied for a
building permit from the City of Edmonds and claims that he/she/it are exempt from providing contractor
registration in accordance with the provisions of RCW 18.27. The property owner or authorized person,
by their signature below hereby verifies to the City of Edmonds that.
❑ Value of work under $500.00. The aggregate contract price of labor and materials
and all other items required for the project is less than $500.00 and is not part of a larger
operation to be undertaken on the property. The person employed to do this work has not
advertised nor otherwise put himself/herself forward to the permittee to be a contractor or
qualified to engage in the business of a contract. RCW 18.27.090(9).
❑ Work performed personally on own property. The undersigned verifies that all work
done under this permit will be done by the permittee personally on his/her own property
and that the improvements constructed on the property are not being undertaken with the
intention and purpose of selling the improved property.
roper a mption. The permittee is the owner of commercial
property and the owner's own employees will perform all maintenance, repair and
alteration work on the property. No work will be done by contract under the permit. RCW
18.27.090(13).
ngine ectrician or plumber. All work performed under this
permit will be performed by an architect, civil or professional engineer, licensed electrician
or licensed plumber operating within the scope of his or her license. RCW 18.27.090(14).
General Contractor. The owner is the General Contractor for the project and is WA -
required to hire a minimum of two licensed subcontractors (unrelated building trades or
crafts) to work on the permitted project. The general contractor is responsible to verify all
State licenses of all subcontractors on the job. RCW 18.27.010
THE UNDERSIGNED PROPERTY OWNER OR AUTHORIZED PERSON HEREBY
VERIFIES THAT ALL INFORMATION PROVIDED ON THIS FORM IS TRUE AND ACCURATE
TO THE BEST OF HIS OR HER KNOWLEDGE AND ACKNOWLEDGES THAT IF ANY OF THE
INFORMATION PROVIDED ON THIS FORM IS FALSE HE OR SHE UNDERSTANDS THAT THE
BUILDING PERMIT WILL BE IMMEDIATELY REVOKED AND ALL FEES PAID FORFEITED.
Dated this �Sr�day of MAY , 200_7
PROPERTY OWNER/AUTHORIZED
PERSON
Signature
L. q) SU1-t-
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LATEMPTUILDrNGWORM "emp contractor regis verif form.doc04/06107
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