You may be eligible for an extension of the due date provided you complete this extension request form justifying your request. Mail or fax in your
request to the address/fax number listed above. Extension requests must be received prior to the due date.
I hereby certify that: I am authorized to make this extension request; all information provided on this extension request or in other submittals is true and
accurate to the best of my knowledge; authorization from the owner to perform the proposed work has been granted; all work performed as part of any permit
will comply with all applicable state and municipal laws and ordinances, and any required contractor license, personal license, or certificate of competency will
be obtained prior to any work being performed. I understand that the issuance of a permit does not grant any contractor license, certificate of competency,
business license, or other license, and unlicensed persons shall not be hired to perform work that requires a license or certificate of competency. I have read this
Acknowledgement of Responsibility Agreement and fully comply with the conditions set forth above.
HOMEOWNERS ONLY: Homeowners requesting the license exemption in MCO89.30 for a (mechanical or plumbing) permit are required to reside in the dwelling
for which the permit is issued.
Development Services
Construction Code Services
Truth in Sale of Housing
250 South 4
th
Street – Room 300
Minneapolis, MN 55415 – 1316
Office 612-673-5840
Fax 612-673-2437
www.minneapolismn.gov/ccs
Office Use Only
Date All Submittals Received________________________________
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