HomeMy WebLinkAboutBuilding Permit Applicant Property Owner I
i
detats t dig State ursota:r
fat sIl -side ni al bu%dxng qqntxacto�rs,xeztxode�and roofers obta t a state fic se,
artless the q�zali y fr&a spwifie a emption ficoi the Iz g zeclui emei s:.`I'his li .
r q�xzremerit spp e, owners 100resident�.ai red estate who build tax prose:: �t e
P o +erly fob f Vecula,'oL�_0. resets_
BY signing this document:I attest to the fact that I am improving this house for ray own
use and am not building or improving this house for the
claim to be exempt from the state licensingpurpose of reselling it_I hereby
of building or rexnodeli�rzg on speculation or four -resale and that t the house fo not�w ch I the mess
aPPlYing for this permit, located at ,3 am
is the only residential structure I have
bail_or improved izt 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:nay otherwise have been entitled under Minn. Scat_ §514.01,
Fherzt�tre I a�k�oe that ,maybe h g indepea t e""O*to per£oxir min aspects f the c€s tst iict ors ar improvement ofV*US house at3�;I i. e�tsta d that:
some of these C+aUtractos.ma be r xed'to be:lceIIseci bg#'he Sf ,of lAaeso�z.I.
Y
�a �t mthcensed zes dentzai con# ac p retx�odex jai,
auc.... tng,act i is a
triisdenxanct�c:tder Scat § 25S.1�82;sub(: ti1 fur.
aid can asv result ix iif .ca
c state tbxt T derstaw that the filing-,of aUIse staterner7t withI►x'de�x may else result in pr..asecutlon ad/or c vzl penalties
tit app zeal,Ie catty-Ordinances and/or state statutes:
I have:also heeri'irtfdrt�x�d ackitowledgp that:by listing trtyselF s ca actc�rfar
this prpject, .a er e e respor�sszble tolhe.cit efFi tdley Qz c�r�nrtplia e.:�l ells ' i - 4
pp cakte.bztxlcitxa We aad city ordxeas Sze�uof heiag.prefflzari do iias
proper :
Signature of Property()weer
Date
i For questions or ilrFormation on contractor licensing,or to checle the licensing status and enforcecrtent
history of a particular contractor,call the Minnesota Department of Labor and dndustry,construction
Codes and Licensing Division,at(651)284-5069.The web site is:I�E€z:/ri�yvw:.el.li.inn ltl