HomeMy WebLinkAbout714 Remington St - Miscellaneous - 05/07/2001Bu i I d i ng & Zoning Dept. For N. College Avenue, P.O. Box 580
Fort Collins, Colorado 80522-0580
Community Planning and Environmental Services Phone: 970 2216760 FAX: 970 224 6134
BUILDING OWNER OR BUILDING OWNER'S AGENT/
EMPLOYEE CONSTRUCTION AUTHORIZATION AFFIDAVIT City of Fort Collins
(PLEASE PRINT)
I/We, ZAIV/1//F_ 6/ Nrr19.1v , as owner(s) of record of the property
located at: 7/�Z I'FLE-e-M ✓,4-7-dn/ i Fort Collins, Colorado, hereby declare and attest
to the following:
I 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, Itwe 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
violates7 the Contractor -License provisions of the Fort Collins Lode, and -will -result in revocation of the
above permit.
/we acknowledge having read PPM 57 and understand the limitations therein.
Owner
Agent
STATE OF COLORADO )
)SS.
COUNTY OF LARIMER )
The foregoing Affidavit was acknowledged before me this day of Ctti �i
19_, by TO Vl t ) i f- 0- C' C C �1 4-0 r)
Witness my hand and official seal.
My Commission expires:
r 10, 200�
MycommmionEviresNovembe _Notary, Public
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