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FRIDLOFY
BUILDING PERNVBT APPLICANT: PROPERTY O"VINER
I, rn1--� 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
Cequirement 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 11oi for My Own
use and am riot building or proving this house for the pu-pose of reselling iL I hereby
elazrn to be exempt fromthu. state icensing requirements because I ate not in the business
of btzldinc or rernadeliztg or: speculation odor resale and t1"at r�,e '•�-.way f , r
applying for this permit, located at l + J h.ich T am
is the onl residential sn-u r� � N� f+dl �m (1 �ss'�
TCuze I have built or improved in the past?4 mor:_
acl o�vIedgd that because I do not have a to license, I forfeit any mechaT ic's lien
rights to which I may otherwise .?gave beers entitled ur?ezMizn. S'at_ §51 .0 1.
Furthermore, I acknowledge that I may be hi—ring independent contractors to e form
n or improvement of this house and I understa�-!d that
certain aspects of floe construction
some of these contractors may required to.be licensed by the State of lvIlrMesota. I
,understand that uniicensed residential con*xact'4, remodeling; aacb r ,'�)ofang activity is a
znisderneanor under Minn. Stat. 32
$10,000_ [ further state that I understand hatsthe filin of a alubd. 16 and can se s result to a one of up to
The Ca of Fridie may also result in cuiminal prosecution andlor civil penalties
to applicable city ordinances andt'or state statutes.
l have also been, informed and acknowledge that by listing myself as the contractor
this project, I alone will be responsible to The City of Fridley for corn for
all applicable building codes and city ordinances with the cv compliance will
property. ork being preformed on this
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For ue� scions or inforrnation on contractor licensing,
history of a particular contJMctor, cat[ the minnusotu Depflitment of Labor and [ndust
or to check the licensing status and enforcement
Codes and Licensing Division, at(65[) 234-5069, The Web site is: or Wld•dli mn
t?�COrtstruction
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