HomeMy WebLinkAbout1706 Deweese St - Affidavits/Homeowner - 03/12/2009• f'bp11?` h ` 1 t y
Community..Planning'_and Enviranmental_Services__
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Building and Zoning Department
M HOMEOWNER/BUILDER AFFIDAVIT
City:,nof Fort Collins:
as, owner(s) of record of the property located
(Please print).
at: /766 ")p,.JQ_-Q�__ Fort Collins, Colorado, hereby declare and attest to
(Please print)
the following: (ple'asz check A, 8 or C, whichever applies)
a 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 primary residence;. I/we.:have not personally constructed any other, new home in Fort .
Collins city limits within the:past 24-m._,onth period:
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 to,my/our home. The home to be altered is on the
above°property and is my/our personal residence.
❑ _ C. I am/we are acting on my/our behalf for the purpose of obtaining a building permit and
personally constructing a non-structural alteration to my/our attached single family 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.
lam/we are personally performing all of the work, or will be continuously supervising unpaid volunteers.
The work is directly related to n f ab ve%referenced home which is described more
fully on Permit.Application;� _q� � A (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 /Notary ublic
Owner Owner `
The foregoing Afndavit was acknowledged before me on this �Iz _day of
iylQrc1n I unq (month, year)by Allo-+theiu �nw�ll (?Hernak
Witness my hand and official Y Pie
UJ_"f
My commission expires: Notary Public
My COMMISSION EXPIRES: uo U
2S1 North College Avenue P.dPW§BVi4ort Collins, CO 80522-0580 • (970) 221-6760 FAX (970) 224-6134