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ACKNOWLEDGEMENT AND CERTIFICATION This acknowledgement must be signed by any person, corporation or entity applying for a permit. If you are acting on behalf of another person, you are also signing on their behalf. Name of person applying for a building permit (please print) Property Information Project Address: City: Name of Owner(s): I am applying to the City of Missoula for a permit related to the property identified above. 1. I understand that if the property will be used for residential purposes, that it is unlawful to discriminate against any person at the property because of race, color, religion, creed, sex, national origin, age, familial status, marital status or disability and that discrimination is a violation of state and/or federal fair housing laws.* I also understand that fair housing laws include requirements to design and build accessible housing in buildings with four or more dwelling units, or on undivided properties with four or more dwelling units. I agree to abide by all fair housing laws that apply to the above identified property. 2. I understand that if the property will be used as a place of public accommodation, that state and federal laws** may require that the property be accessible to persons with disabilities. I agree to abide by all state and federal accessibility requirements that apply to the above identified property. (Signature) Date: (Print name) *Fair housing laws include the Federal Fair Housing Act (42 USC 3601 et seq), the fair housing provisions of the Montana Human Rights Act (49-2-305 MCA) and may include other provisions of state or federal laws. For further information, contact the Montana Human Rights Bureau ([PHONE REDACTED]), the United States Department of Housing and Urban Development-HUD ([PHONE REDACTED] Fair Housing Information Clearinghouse), or your local fair housing organization. **Federal and state accessibility requirements are found in the Americans with Disabilities Act (ADA), the public accommodation provisions of the Montana Human Rights Act (49-2-304 MCA) and other provisions of state and/or federal law. For further information, contact the Montana Human Rights Bureau, Montana Advocacy Program ([PHONE REDACTED]) or the U.S. Department of Justice ADA Hotline ([PHONE REDACTED]) DEVELOPMENT SERVICES 435 RYMAN • MISSOULA, MT 59802 - 4297 • (406) 552-6630 • FAX: (406) 552-6053