HomeMy WebLinkAbout6920 Sedgwick Dr - Affidavits/Homeowner - 11/06/2001Building & Zoning Dept
Community Planning and Environmental Services
281 N. College Avenue, P.O. Box 580
Fort Collins, Colorado 80522-0580
Phone: 970 2216760 FAX: 970 224 6134
HOME OWNER -BUILDER AFFIDAVIT
(PLEASE PRINT)
I/We,
y
Ci of Fort Collins
located at e.X-o —'ja wJ as owners) of record of the property
"��� , to the following: Fort Collins, Colorado, hereby declare and attest
am/we are acting on my/our behalf for the purpose of obtaining a building permit for the construction
or alteraltion of my/our home. The home to be constructed or altered is on the above property and
is mylour 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.
Building &Zoning Office). 0 1 ( tain from
3
2 8
1/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,
electrical work, or roofing, MUST BE licensed contractors in accordance with the regulations atio Plumbing, HVAC,
Collins. 9 ns of Fort
5. I/we understand that failure to comply with any of the above conditions may result in revocation of an
permits associated with the above Application Number, and forfeiture of any fees that have been
collected.
Owner
Owner
STATE OF COLORADO )
COUNTY OF LARIMER jss.
The foregoing Affidavit was acknowledged before me this
day ofr 19 , by %2r'�C>0�e='e-e
Witness my hand and official seal.
My Commission expires:
,, i No�ry Public