HomeMy WebLinkAbout613 Blue Mesa Ave - Affidavits/Homeowner - 09/19/2009Community Tlanning.and. Environmental Services
Building and Zoning Depaitment.
HOMEOWNER/BUILDER AFFIDAVIT
I/we, as owners). of record of the property lgcated
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at. ram, t (j--c A-s� - , Fort Collins, Colorado, hereby declare and attest to
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the following::(p/ease check A, B orC, whichever -applies)'
o A. I am/ we are acting on my/our behalf for the purpose of obtaining a building permit and
personally constructing. my/our- home. The home to be constructed. is. on the above property and
will -be my./our pririnary residence..; I/we have not p rp sonally constructed any.other new -home in Fort
/Collins city limits within the -past 24-month period; ;.
uv B. I am/we are acting on my/our behalf for the purpose of obtaining :a building permit and
personally constructing an alteration or addition .toy my/our home. The home to be altered is on the
above property and -is my/our personal residence.
a C. I am/we are acting on my/our behalf for the purpose of obtaining a building permit and
personally constructing a nonrstructural alteration to my/our attached sin gle,farnify. dwelling
unit. The home to be altered is our personal residence. I am aware that I/we cannot do any
structural, electrical, plumbing or mechanical work and must hire contractors/subcontractors who
are, currently licensed with the City of Fort Collins.
I am/we are personally performing all of the work, or will be continuously supervising unpaid volunteers.
The work is directly related to the construction of the above referenced home, which is described more
fully on- Permit Application # .(obtained from- Building and Zoning
Office). I/we understand that any persons or agents contracted to perform structural. wood -framing,
plumbing, HVAC, electrical work, roofing or cast -in -place structural concrete work, MUST BE licensed
contractors in accordance -with the'regulation of the City of Fort Collins.
I/we understand that failure to comply with- any of the above conditions may result in revocation of
any permits associated with the. above Permit Application number, forfeiture of any fees that have been
collected, a Stop Work Order and a court summons.
Sign in the presence' of a Notary Public
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Owner
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Mitlommission expir s:
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Owner
was acknowledged before me on this dav of
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281 North College Avenue 3 PO. Box 580 o Fort Collins, CO 80522-0580 a (970) 2�f 67�0 a FAX (970) 224-6134