HomeMy WebLinkAbout4121 Sunstone Dr - Miscellaneous - 01/01/2000ege Avenue,
Box
Building & Zoning Dept . Fort Co Collins, Colorado 8 522-0580 80
Community Planning and Environmental Services Phone: 970 2216760 FAX: 970 224 6134
HOME OWNER -BUILDER AFFIDAVIT
Cfty of Fort Collins
(PLEASE PRINT)
I/We,12k
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, as owner(s) of record of the property
located at:
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Fort Collins, Colorado, hereby declare and attest
to the following:
1. 1 am/we are acting on my/our behalf for the purpose of obtaining a building permit for the construction
or alteraltion of my/our home. The home to be constructed or altered is on the above property and
is my/our personal residence.
2. 1 am/we are personally performing all of the work, or supervising unpaid volunteers or "employees" (see
PPM 58 attached) who might be assisting with any of the work related to the construction of the above -
referenced home, which is described more fully on Permit Application No. (obtain from
Building & Zoning Office).
3, I/we have not personally constructed any other new home within the past 12-month period.
4. I/we understand that any persons or agents contracted to perform structural framing, plumbing, HVAC,
electrical work, or roofing, MUST BE licensed contractors in accordance with the regulations of Fort
Collins.
5. I/we understand that failure to comply with any of the above conditions may result in revocation of any
permits associated with the above Application Number, and forfeiture of any fees that have been
collected.
Owner Owner
STATE OF COLORADO )
)SS.
COUNTY OF LARIMER )
The foregoing Affidavit
19eWl , by
acknowledged before me this 4l day of
i
Witness my hand and official seal.
My Commission expires:
My ComrrAesion Expires November 10, 2002
9948(09
r
Notary Public