20240422132318EXEMPTION 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 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. 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 1827.090(11).
❑ 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).
/ \ Use of own employees. Property owner using him/herself or his/her own employees to perform
maintenance, repair, and alteration work in or upon his/her own property. RCW18.27.090(13).
❑ Licensed Architect, Engineer, Electrician or Plumber. All work performed under this permit will be
performed by an architect, civil or professional engineer, certified electrician or certified plumber
operating within the scope of his/her certification. RCW 18.72.090(14).
❑ Other. Specify which provision of RCW 18.27.090 applies:
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 IMMIEDIATELY REVOKED AND
ALL FEES PAID FORFEITED.
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DATED this .2 Z day of ", 20
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