HomeMy WebLinkAboutSwick Building Applicant Property Owner Form DocuSign Envelope ID:5ED626D7-F04A-472C-A01 F-D82805C523E5
CITYrO
PROD
BUILDING PERMIT APPLICANT: PROPERTY OWNER
I,_Jeffrey Swick understand that the State of
Minnesota requires that all residential building contractors, remodelers and roofers obtain
a state license unless they qualify for a specific exemption from the licensing
requirements. This license requirement applies to owners of residential real estate who
build or improve 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. I hereby
claim 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 am
applying for this permit, located at _6190 Rice Creek Dr. NE, Fridley, MN
55432 is the only residential
structure I have 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 Linder Mirn. Stat. §514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to perform
certain aspects of the construction or improvement 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. Stat. §326B.082,subd. 16 and can also result in a fine of up
to $10,000. I further state that I understand that the filing of a false statement with
The City of Friclley may also result in criminal prosecution and/or civil penalties
to applicable city ordinances and/or state statutes.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to The City of Fridley for compliance will
all applicable building codes and city ordinances with the work being preformed on this
property. tlew,
agi"a'fure of Property Owner
5/5/2022
Date
For questions or information on contractor licensing, or to check the licensing status and enforcement
history of a particular contractor, call the Minnesota Department of Labor and Industry,Construction
Codes and Licensing Division, at(651)284-5069.The web site is: littp://www.dli.mti.aov/Ccid.am