HomeMy WebLinkAbout520 Kim Dr - Affidavits/Homeowner - 02/05/2007Community Planning and Environmental Services
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HOMEOWNER/BUILDER AFFIDAVIT
City of Fort Collins
I/we,5e&z6t�7;2' 5 M4Z&Z I, as owner(s) of record of the property located
(please print)
at:Fort Collins, Colorado, hereby declare and attest to
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the following: (please check A, S or C, whichever applies)
❑ A. I am/ we are acting on my/our behalf for the purpose of obtaining a building permit and
personally constructing my/our home. The home to be constructed is on the above property and
will. be my/our primary residence. I/we have not personally constructed any other new home in Fort
Collins city limits within the past 24-month period.
B. I am/we are acting on my/our behalf for the purpose of obtaining a building permit and
personally constructing an alteration or addition to my/our home. The home to be altered is on the
above property and is my/our personal residence.
❑ C. I am/we are acting on my/our behalf for the purpose of obtaining a building permit and personally
constructing a non-structural alteration to my/our attached single family dwelling unit. The
home to be altered is my personal residence. I am aware that I/we cannot downy structural,
electrical, plumbing, or mechanical work and must hire contractors/subcontractors who are
currently licensed with the City of Fort Collins.
I am/we are personally performing all of the work, or will be continuously supervising unpaid volunteers.
The work is directly relat o 0 of eAbove referenced home, which is described more
fully on Permit Applicatio �� ��� (obtained from Building and Zoning Office).
I/we understand that any persons or agents contracted to perform structural wood -framing, plumbing,
HVAC, electrical work, roofing or cast -in -place structural concrete work, MUST BE licensed contractors
in accordance with the regulation of the City of Fort Collins.
I/we understand that failure to comply with any of the above conditions may result in revocation of
any permits associated with the above Permit Application number, forfeiture of any fees that have been
collected, a Stop Work Order and a court summons:
Sign in the of a Notary Public
�..
Owner Owner
The foregoing Affidavit was acknowledged before me on this day of
a00 —7 (month, year)by Py,31�'C-00j//AcL�,C;
i
Witness my hand and official seal
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My commission expires: _1
281 North College Avenue • P.O. Box 580 • Fort Collins, CO 80522-0580 • (970) 227-C,C76EY• FA\ (970) 224-6134