HomeMy WebLinkAbout2627 Redwing Rd - Miscellaneous - 10/25/2000 (3)001650
281 N. College Avenue, P.O. Box 580
Building &Zoning Dept,
522-0580
Community Planning and Environmental Services Pho eFort o1lins970 2116760 orado 8 FAX: 970 224 6134 t
BUILDING OWNER OR BUILDING OWNER'S AGENT/
EMPLOYEE CONSTRUCTION AUTHORIZATION AFFIDAVIT CitV of Fort Collins
I/We,
located at:
to the following:
(PLEASE PRINT)
as owner(s) of record of the property
1 H ! Fort Collins, Colorado, hereby declare and attest
�1 Rei_ ' d
❑ 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 1�,,, , �,�
my/our behalf for the purposes o, t a buildin (Agent) to act on
9 g 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 )
Owner
Agent
The foregoing Affidavit was acknowledged before me this day of
by _ ��Ltic�-�t.4� �(� � v�i
Witness my hand and official seal.
My Commission expires: c, -e-
Notary Public