HomeMy WebLinkAbout509 E Myrtle St - Affidavits/Homeowner - 09/07/1999Building & Zoning Dept 281N•College Avenue, P.O.Box 580
Community Planning and Environmental Services Fort Collins, Colorado 80522-0580
Phone: 970 221 6760 FAX: 970 224 6134
HOME OWNER -BUILDER AFFIDAVIT
(PLEASE PRINT)
UWe, A7
located at: -3 0 11 'E_
to the following:
as owner(s) of record of the property
Fort Collins, Colorado, hereby declare and attest
1. 1 am/we are acting on my/our behalf for the purpose of obtaining a_ building permit -for -ore construction
or alteraltion of mylour 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. i_ (Obtain from
Building & toning 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. -7 9 �j
Owner
Owner
STATE OF COLORADO )
COUNTY OF LARIMER jss.
19�The foregoing Affidavit was acknowledged before me this (�_ lday of
, by __b rr y
Witness my hand and official seal.
My Commission expires:
n mmWslon Expires November 10, 2002
�f to ary Public