HomeMy WebLinkAbout5529 S Timberline Rd - Miscellaneous - 04/17/2001Building &Zoning Dept. 281 N. College Avenue, P.O. Box 580
Fort Collins, Colorado 80522-0580
Community Planning and Environmental Services Phone: 970 2216760 FAX: 970 224 6134"'
IF
BUILDING OWNER OR BUILDING OWNER'S AGENT/ i
EMPLOYEE CONSTRUCTION AUTHORIZATION AFFIDAVIT city of Fort Collins
I/We, 4&00 S26t-Ser 66IR 021
aIner(s) of record of the property
located at: Y Kip Wd- • Fort Collins, Colorado, hereby declare and attest
to the following:
1 am/we are acting on my/our behalf for the purpose of obtaining a building permit for minor alterations
to the building referenced above. I am/we are personally performing all of the work as described on
permit/app # : or
❑ I/we do authorize , (Agent) to act on
my/our behalf for the purposes of obtaining a building permit for minor alterations to the building
referenced above. Said Agent will be personally performing all of the work as described on permit/app
I/we understand that the Agent named above is not a contractor and is my/our employee as defined by
Colorado law; or, is acting on my/our behalf without any fee, compensation, or trade in -kind for the
above work.
Further, I/we understand that payment of such fees or compensation for the above work, to any person
who is not my/our employee as prescribed by Colorado law, constitutes a "construction contract" and
violates the Contractor License provisions of the Fort Collins Code, and will result in revocation of the
above permit.
I/we acknowledge having read PPM 57 and understand the limitations therein.
Owner
STATE OF COLORADO )
)ss.
COUNTY OF LARIMER )
The foregoing Affidavit was
by
Witness my hafid and official seal.
My Commission expires:
My Commission Expires November 10, 2002
before me this l day of
Owner
Agent