HomeMy WebLinkAboutPermit App Form i
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BUILDING PERMIT APPLICANT: PROPERTY ONVINER
I: MtcH E1, �D�EY "�RHf-S7Eu r , understand that the State of Minnesota requires
that all reszdentzaI b ildiug contractors, remodelers and roofers obtain a state license
runless they qualify for a specific exemption from the licensing requirements. 'This license
regttireixtent applies to o'Aners of residential real estate who build or irnprove such
property for purposes of speculation or resale.
By signing this document, I attest to the fact that I am improving this house for my own
use and am not building or improving this house for the purpose of reselling it-1 hereby
claof
to be exempt from the state licensing requirements because I am not in the business
of building or remodeling on speculation or for resale and that the house for which I ain
applying for this permit, located at
6424 is the only residential structure I have tU8M:R QvE WE �RIOLtY �NNtiSG
—�—,
built or improved in the past 24 months. I also
acknowledge that because I do not have a state license, I forfeit any mechanic's lien
rights to which I may otherwise have been entitled under Mirin. Stat. §514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to perzoixl7
certain aspects Of the construction or improveinent of this house and.I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is a
misdemeanor under Minn. Star. §326B.082, subd. 16 and can also result in a fine of up to
S t 07000- I fitrther state that I understand that the filing of a false statement with
Dle City of.�ri ev may also result in criminal prosecution and/or civil pe*zalti s
to applicable city ordinances and/or state statutes.
I have also been inforined and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to T dley for compliance will
all applicable build' codes and city ordinances with the work being preformed on this
Signature of Property Owner
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For questions or information on contractor licensing, or to check the licensing status and enforcement
history of a particular contractor, call the 1Vlirinesota Department of Labor and Industry, Construction
Codes and Licensing, Division, at(651)284-5069. The web site is: