HomeMy WebLinkAbout185 N College Ave - Affidavits/Owner Authorization - 12/19/2000281 N. oege Avenue,
Box
Building & Zoning Dept. Fort Co lins, Colorado 805202-0580 80
Community Planning and Environmental Services Phone: 970 2216760 FAX: 970 224 6134
BUILDING OWNER OR BUILDING OWNER'S AGENT/
EMPLOYEE CONSTRUCTION AUTHORIZATION AMUN401111 a" Qfity-of Fort Collins
(PLEASE PRINT)
yvvc, nca �P , ��, e - as owner(s) of record of the property
located at: /8'S� N. /�//%`�¢z�.� 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
Od 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 Own r
Agent
STATE OF COLORADO )
)ss.
COUNTY OF LARIMER )
Witness my hand and official seal.
My Commission expireK.risti L. Meyer
Notary Public - Colorado
Larimer County