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PRINCE GEORGE S COUNTY Department of Permitting Inspections and Enforcement PERMITTING AND LICENSING DIVISION Date HOMEOWNER IMPROVEMENT AUTHORIZATION LETTER You must read this document of consent prior to completing and signing The Homeowner Improvement Authorization Letter that you are completing only authorizes the individual to apply for the permit on the Homeowner s behalf. This letter does not authorize the individual applying for this permit to perform the scope of work. Property Location of Work Property Tax Account Number Homeowner s Signature Telephone Number The Maryland State Home Improvement Commission MHIC is there to protect you. If you have any questions regarding a contractor contact the MHIC office at 410 230 6309 501 Saint Paul Place Baltimore Maryland 21202 or online at http //www. dllr. state. md. us This Authorization Letter must be notarized within the last 30 days. My Commission Expires Notary Public Important Notice Prior to consideration this document must be completed in its entirety and must not be written over or altered in any manner. Only the Licensed Contractor or Homeowner named on the PERMIT as contractor is permitted to perform the scope of work on the permit at the address specified* I understand that any contractor I contract for this work who does not have a Maryland State Home Improvement License is subject to a 5 000 fine or Imprisonment not to exceed two years or both. As the homeowner I hereby authorize the person listed below to be my representative on the application for a permit. Authorized Agent If you have selected a contractor please send a copy of his/her current Maryland State Home Improvement License. Property Location of Work Property Tax Account Number Homeowner s Signature Telephone Number The Maryland State Home Improvement Commission MHIC is there to protect you. If you have any questions regarding a contractor contact the MHIC office at 410 230 6309 501 Saint Paul Place Baltimore Maryland 21202 or online at http //www. dllr. state. md. us This Authorization Letter must be notarized within the last 30 days. My Commission Expires Notary Public Important Notice Prior to consideration this document must be completed in its entirety and must not be written over or altered in any manner. Only the Licensed Contractor or Homeowner named on the PERMIT as contractor is permitted to perform the scope of work on the permit at the address specified* I understand that any contractor I contract for this work who does not have a Maryland State Home Improvement License is subject to a 5 000 fine or Imprisonment not to exceed two years or both. As the homeowner I hereby authorize the person listed below to be my representative on the application for a permit. As the homeowner I hereby authorize the person listed below to be my representative on the application for a permit. Authorized Agent If you have selected a contractor please send a copy of his/her current Maryland State Home Improvement License. Authorized Agent If you have selected a contractor please send a copy of his/her current Maryland State Home Improvement License. Property Location of Work Property Tax Account Number Homeowner s Signature Telephone Number The Maryland State Home Improvement Commission MHIC is there to protect you.

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