EAGLE HARBOR TOWNSHIP

CONTRACTOR AFFIDAVIT 321 Center Street • Eagle Harbor, MI 49950 • (906) 289-4407 • FAX (906) 289-4462 ALL INFORMATION IS REQUIRED

Date

Company Name

Owner(s) Name

Mailing Address

Mailing Address

City

State

Day Phone

Evening Phone

Zip code

City Day Phone

State Evening Phone

Building License

License Number

Expiration Date

Maintenance & Alteration

License Number

Expiration Date

Electrical License

License Number

Expiration Date

Mechanical License

License Number

Expiration Date

Plumbing License

License Number

Expiration Date

Boiler License

License Number

Expiration Date

MESC Number

Zip code

Federal I.D. Number

If none, reason for exemption:

I certify the information on and accompanying this application to be complete, true and correct under penalty of perjury by the laws of the State of Michigan. Authorized Signature(s) (Letter of authorization required if other than owner):

Date

NOTES: • Individuals and companies performing residential construction, or a combination residential/commercial construction totaling $600 or more in materials and labor must be licensed as either a residential builder or a maintenance and alteration contractor. Individuals or companies providing services totaling less than $600 in materials and labor or who are functioning as a subcontractor for a licensed contractor on a residential or combination residential/commercial construction project are exempt from licensure. •

Unlicensed Activity – Effective December 21, 2007, penalties were increased for a person practicing as a Residential Builder or Maintenance and Alteration Contractor without a license. First Offense: Misdemeanor Fine of $5,000 - $25,000, or prison for not more than 1 year, or both.* Second and Subsequent Offenses: Fine of $5,000 to $25,000, or prison for not more than 2 years, or both.* *If the offense causes death or serious injury it is a Felony. Fine of $5,000 - $25,000, or prison for not more than 4 years, or both.

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Michigan Compiled Law prohibits a person from conspiring to circumvent the licensing requirements of the state relating to persons who are to perform work on a residential building or residential structure.

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The license lookup is one of the online services at www.michigan.gov and also available directly at http://www.dleg.state.mi.us/verify.htm. Consumers who want personal assistance in looking up a license can call the Builders Licensing Unit at 517-241-9254. Rev 1