HomeMy WebLinkAbout3930 Benthaven St - Affidavits/Homeowner - 03/22/2007COII1171 UI LI' 'P I aI'lL,I I,,rI ll d }_'. IV iC,L=5
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!N 4'1,1-e A L-lO 4,, P as owners' of record of the property/ located
(pl^ase prinC)
at: 8e211-h G Fort Collins, Colorado, hereby declare and attest to
(phase print)
thefollowing: (p/ear e check: A; 6 or C, iahi_h� ver applies)
o .�. ] 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.
f 6. I am/we are acting on my/our behar` 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 awing 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 do any structural,
electrical, plumbing, or mechanical work and must hire contractorslsubcontractors who are
currently licensed with the Cite of Fort Collins.
I am/we are personally performing all of the work:, or will be continuously supervising unpaid volunteers.
The work is dire_-tly related to the constru pion of the above referenced home, which is described more
fully on Permit Application # (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, for, eiture of any fees that have been
collected,.a Stop Work Order and a court summons.
Sign in the presence of a Notarll Public
Owner
Owner
ged before me on thl day of
year)by GU �-I
Notary Pub is
�f1 No?61 Colle e A��enue • P.O. Fcn: FS'0 ^ Port Co]]ins, CO SOi2 -0550 - (910i 221-6760 • LA_,: (�170) 234-673'4