Signed exemption from contractor formEiWIT-Tt"TIOff, 1 FROM CONTRACTOR
REGISTRATION -VERIFICATION
FORMI)
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 aoin providing
contractor registration, in accordance with the provisions of RCW 18.27. The property o vwmer or
authorized person, by their signature below, hereby verifies to the. City of Edmonds that,
0 Value of work under $500.00. The aggregate contract ontract 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 parson who advertises
or puts out any sip or card or other device -which might indicate to the public that l�e/she is
a contractor, or that he/she is qualified to engage in the: business of contractor. RCW
18.27.090'(9).
EI., owner who conaacts for a project. A property owner con cting with registered
contractors for the project, and who him/herself is not perfon-fting 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).
19— Woeh: peiformed personally on owe. -property. Anyone personally working on property
he/she owns, or ,it 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).
0 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. RCW
18.27,090(13).
0 Licensed Architect, enggm-eer, 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).
0 Other. Specify which provision of RCW 18.27.090 applies:— - __
THE UNDERSIGNED PROPERTY OWNER OR AUTHORIZED PERSON HEREBY VERITIES
THAT ALL INFORMATION PRO'\/TDED ON THIS FORM IS TRUE AND ACCURATE TO THE
BEST OF HIS OR HER KNOWLEDGE AND ACI,,NOWLEDGES THAT IF ANY OF TIM
INFORMATION PROVIDED ON TTHS FORM IS FALSE BE OR SHE UNDERSTANDS THAT THE
BUILDING PERMIT WILL BE EVRVIEDIATELY REVOKED AND ALL FEES PAID FORFEITED.
DATED this ) C) day of 1'
PROPERTY OWI\TER/AUTHOR=D
PERSON.,
,,,Xignature
WITNESS -
Signature
Print Name Print Name
J_ATEMP\I3UILDING\HANDOTJTS REVISED IN 2009\PREVIOUS RANDOUTS\FORMS\CONTRACTOR EXEMPTION FORM
D.DOCREVISED 7/07