Form D Contractor Exemption Kelnero Deck CoverRECEIVED b1d202.1-1706
Jan 17 2022 EXEMPTION FROM CONTRACTOR
CITY OF EDMONDS
DEVELOPMENT SERVICES RE GISTR_,kTION VERIFICATION
DEPARTMENT FORM D
The undersigned property owner or authorized person as described below, has applied for a,
building permit iota the City of Edmonds and claims that he/she/it is exempt from providing
contractor registration in accordance with the provisions of RGW 18,27. The property ovrner or
authorized person, by their signature below, ' her&by verifies
rifies to the City of Edmonds that'-
11 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 exempdon does not apply to a person -1,vho advertises
or put& out any sign ublIlly t fle/she is
.1 or card or other device which might indicate to the p la
a contractor, or that he/she is I quatifled to engage in the business of contractor. RCW
18.27.090,(9).
0 owner ,who contracts for a project, A property owner contractirig, with :registered
contractors for the prbjOct, and who hiiiii/hers . elf is :not perf�.brtfi.ing 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).
rX WoAz peH*ormed person?Ry on own.prop�rty. Anyone po-rsonah World' 9 011 pt-o.petty
he/site owns, or at which .lie/slie resides, as long as. the property owner, or resident, does not
perform any activity of a contractor on bis/her property for the 'pUrposo Of selling,
demolishing, or leasing the property, RCW 18.27.090(12).
11 'Use of ow C'JU ploye-es. Property op owner using hirriilherself or his/her own employees to
perform maintenance, repair, and, alteration work in o.i. upon. hisilicr ovin proloertv. RCW
18.27.090(13). 0 Licensed Architect, eughleer, electxiciin or plund)er. All work performed itnder this
permit will be performed by an architect, civil or professional engineer, certified I fie electrician
ian
or certified plumber operating within the scope ofhis/her certification. .,kCW 18.72.090(14),
0 Other. Specify which provision of RCW 18.27.090 applies:_.___.._.....,..,._
THE UNDERSIGNED. PROPERTY OWNER OR AUTHORIZED PERSON VERIFIES
THAT ALL JNFOp,&LNj.'ION 1?1�,O'4rJDED- ON THIS FOR1\/1 IS TRUE; AND ACCURATE TOTIRE
BEST OF HIS OR HER KNOWLEDGE AND ACKNOWLEDGES -a-IAT IF .ANY OF, T HE
. I .
INFORMATION PROVIDED ON THIS FORTM IS FALSE BE OR SHE UN-Dt3RSTANDS THAT ITIE
BUILDING PERMIT WILL BE 11\4PAEMA�fELY REVOKED AND ALL FEES PAID FORFEITED,
DATED this Is day of
January 2022
P ERTY OT4.ER/ATJTHOR1ZED
W71NESS_
SON i ?
PERSON.
j/
SignatuTe
Z?
Print Name
Pdnt Name
L:\TE*NIP\B*UILDII,fCr\f-iANI')OUTS REVISED IN 2009WEVIOUS RIVNDOUTS\Y"ORD/IS\COI\TT'LZACTORT,XEIVrP'rIONFOI2M
D.DOCREVISED 7107