Johnson_Cory_Form D-Contractor exemptionEXEMPTION FROM CONTRACTOR
REGISTRATION VERD ICATION
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 h6shcht is 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. This exemption does not apply to a person who advertises
or puts out any sign or card or other device which might indicate to the public that He/she is
a contractor, or that he/she is qualified to engage in the business of contractor. RCW
18.27.090.(9).
Owner who contracts for a project- A property owner contracting with registered
contractors for the project, and who him/herself is not performing any activity of a
contractor for the purpose of leasing or selling improved property that he/she has owned for
less than twelve months. RCW 18.27.090(11).
A Work performed personally on own property. Anyone personally working on property
he/she owns, or at which he/she; resides, as long as the property owner, or resident, does not
perform any activity of a contractor on his/her property for the purpose of selling,
demolishing, or leasing the property. RCW 18.27.090(12).
U Use of own employees. Property owner using him/herself or his/her own employee- to
perform maintenance, repair, and alteration work in or upon his/her own property. RCW
18.27.090(13).
U Licensed Architect, engineer, electrician or plumber. All work performed under this
permit will be performed by an architect, civil or profession -I engineer, certified electrician
or certified plumber operating within the scope of his/her certification. RCW 18.72.090(14).
f 1 Other. Specify which provision of RCW 18.27.090 applies:_
THE UNDERSIGNFM PROPERTY OWNER OR AUITiORI7_ED PERSON HEREBY VERIFIES
THAT ALL INFORMATION PROVIDED ON THIS FORM IS TRUE AND ACCURATE TO THE
BEST OF HIS OR HER KNOWLEDGE AND ACIOvOWLEDGES TIIAT IF ANY OF THE
INFORMATION PROVIDED ON THIS FORM IS FALSE HE OR SHE UNDERSTANDS THAT THE
BUILDING PERMrr WILL BE DANIEDIATELY REVOKED AND ALL FEES PAID FORFEfI'FD.
DATED this yl day of �c> /cl 20
PROPERTY OWNT.R/AUTHORIZED
PERSON
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Print Nam'
WITNESS
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