Mercer Island, WA · King County
Contractor’s Statement of Responsibility
Contractors submit this form to acknowledge special requirements for designated wind or seismic force-resisting systems or components before work begins.
What this form is
Mercer Island requires each contractor responsible for designated wind or seismic force-resisting systems or components to submit this statement before work begins. The form identifies the project and contractor, describes the designated systems or components, and records the contractor’s acknowledgments about the Statement of Special Inspections, construction controls, reporting, and responsible personnel.
Who needs it
A contractor responsible for construction, fabrication, or installation of designated wind or seismic force-resisting systems or components must submit this statement.
How to submit it
Submit the statement to the Building Official and the owner before work begins.
About notarization
This statement is signed and dated without a notary; the form mentions no notarized or sworn attachment or related step.
How to submit this form
- 1
Download the Form
Download the Contractor’s Statement of Responsibility PDF.
- 2
Complete Project and Contractor Details
Enter the project, permit, company, contact, and designated system information requested on the form.
- 3
Review the Special Inspections Statement
Read the Test and Inspection program and Statement of Special Inspections referenced in the contractor acknowledgment.
- 4
Sign and Date
Sign and date the contractor acknowledgment.
- 5
Submit Before Work Begins
Submit the statement to the Building Official and the owner before work begins.
Frequently asked questions
- What is the Contractor’s Statement of Responsibility?
- It records a contractor’s project and company information and acknowledges special requirements and responsibilities for designated wind or seismic systems or components.
- Who submits this statement?
- Each contractor responsible for construction, fabrication, or installation of a designated wind or seismic force-resisting system or component submits it to the Building Official and owner.
- Do I need a notary for the Contractor’s Statement of Responsibility?
- No. The form is signed and dated without a notary and mentions no notarized or sworn attachment or related step.
- How do I submit the statement?
- Submit it to the Building Official and the owner before work begins.
Need something notarized?
This Contractor’s Statement of Responsibility doesn’t need a notary — but if you have another Mercer Island form that does, a commissioned online notary can help.