adams ownexp.pdfEXEMPTION FROM CONTRACTOR LON
VERIFICATION FORM JAN 18 2007
The undersigned property owner or contractor has applied for a bVift f VOW Tthe City of
Edmonds and claims that he/she/it are exempt from providing contractor registrati�u° accordance with
the provisions of RCW 18.27. The property owner, 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
opertation to be undertaken on the property. The person employed to do this work has not
advertised nor otherwise put himself 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.
❑ Commercial property exemption. 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).
❑ Licensed architect, engineer, electrician 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 ro'ect and is required
p J
to hire a minimum of two licensed subcontractors (unrelated building trades or crafts)_ The
general contractor is responsible to verify all State licenses of subcontractor. RCW
18.27.010
THE UNDERSIGNED PROPERTY OWNER 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 •3 day of CA 2001"-7
PROPERTY OWNER/PERMITTEE
Signature
nCA tmam S
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LATEMPIBU]LD NG\F'ORMSlexemp contractor regis verif fonn.doc02/01/06
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