HomeMy WebLinkAboutbuilding permit application MC%L%
BL IL-0rl~J G.PE T A.PPtjC! ,NT:;lPR OpE TY O Vt rEl
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,understand thafi'ilre Mate of Nlimiesota requires:that.41l residezitial building.contractors,remodeler and.roofexs obtaxzi,a state lieequi twlcss they q�xali y£or,a specific e; exnption hrom.,the lioetM�ag xequxiexrieuts.This'license
regt ireunent applies tO,Owners'Offfti dtial real estate who build or;irnptove sucli
property;for ptut;poses of speculation'lor resale;
By signing this document,I attest to the fact that I am iznprovixig this house for my oven
use and amnot 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 le/�j� <<s�tt vl�
is the only residential structure I have built or improved in the past 24 months. I o irS�`3Z
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 Minn.. Stat. §514,01,
Furthermore, I aclglowl''6dge that I may be bitng indepeadexit a'oz ttacioxs to pez, r.certain aspects of the cozrstr�tGtlon or lrn
xnpro,voment ofIhis house and'Z understand tk�tzt
some ofthese contractor
erstand;that tin ce44ed q
urrd o f Milinesot
s mgy�be re dared to be lioensed b. the Stafie
thisde.meaxror under lU.Cixam�. Sta e326L3 082 s bd�l an can and/�ox'roofxng,sctr ty;is a
a a result in a ft, .of trp.ro
"$I0,PX T further state that.--ttrudetstand"tha the filing ova false statemoult with;
The l-cl off may also result in criminal prosecrttlon acid/or cNi penalties
to'applicable city ordiiia ces zid/or,state statutes.
I leave also been inforted and.,acknowledge that by listing thyself as,the contzaetor'ior
this project, T alone will be responsible to The+City of>i�y"ox compliance will
all applicable building codes acid city drdixr_ s witli tl-e work being prdommed on this
'px operty.
Signature of roperty Owner
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; 1711n:/llwm ww c(I1i,iti Gov/Ccld.usp