HomeMy WebLinkAboutpermit App �C�'�D t
BULI'_,DWn PT,P Y.tTT A PPLTCIA 7,r- RD OGrfi(E7.
,za,~ 1 Uliderstand that
thc Of Minnesota at all residential building contractors, remodel:ers and roofethe rs tobtain a stateUnles licerrsc�cs
requis they duali � for a specific e emPtion frorn the licensing recluirernents:This licezase
cecluiretrient applies to owners or residential reiil 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 btailding 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 '" `7 �
is the only residential structure I have built or improved in the,past 24 months. I also LI "
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.
Ftzrdaea.-more, I acknowledge that I may be hiring independent contraccCoz•s to perform
cer�:aizl aspects of the co, strtrction or itzaprovement Oft(-is house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understaxa,d. that unlicensed residential contracting, remodeling, and/or roofing activity is a
misdemeanor under Minn. Stat. §326B4O82, subd. 16 and can also result in a fine of rip to
$10,000. I further state that I understand that Lh.e filing of a false statement with
1 e Qi- of.�"rj ey may also result in criminal prosecution and/or civil penalties
to applicable ciq, ordinances and/or state statutes.
I have also beett informed and acknowledge that by listing Enyself as the Contractor for
this project, I alone will be responsible to Th �it/ of Fridley for compliance w-i j
all , building codes and city ordinaac ith the wor1G l�eirtg preformed on this
Property.
Signature of Property Owner
--- 7
Date
For questions or information on contractor licensing,or to check the licensing status and enforcement
history of a particular contractor, call the Minnesota Departrnent of Labor and Industry, Construction
Codes and Licensing Division, at(651)284-5069.The web site is: fittL) / v�-,,dll.rnti, qv/�;:c ltL stj