HomeMy WebLinkAbout2703 Rock Creek Dr - Affidavits/Homeowner - 05/08/2007Cornmuni+v Planning and Enidronmental Services
Building and Bonin- Department
HOMEOWNER/BUILDER AFFIDAVIT
Cite of Fort Collins
I/we, _ `?(�� "���`>c as owner(s) of record of the property located
(please print)
at: /�£ �Z Fort Collins, Colorado, hereby declare and attest to
(please print)
the following: (p/ease chec%A, 5 or C, whichever appl es)
❑ A. Imo/ 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 our personal residence. I am aware that I/we cannot do any
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 personallyperforming all of the work, or will be cont rile Yos n 1 o teers.
The work is directly rzapd to thegconstruction of the above referent nar(ijp1vQ
Iw ced pore
fully or, Permit Application 13 V -7 0 aa(o(obtained from Building and Zoning
Office). I/we understand that any persons or agents contracted to perform structural wood -framing,
plumL)ing, 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 presence of a Notary Public
`— Owner
foregoing Aff4AawiWQs acknowledged before me on this da of
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Witness rr2 han0dT �al �Z}I
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