HomeMy WebLinkAbout123 N College Ave - Miscellaneous/Owner Agent - 10/18/2007Building &Zoning Dept. 281 N. College Avenue, P.O. Box 580
Fort Collins, Colorado 80522-0580
Community Planning and Environmental Services Phone: 970 2216760 FAX: 970 224 6134
i
BUILDING OWNER OR BUILDING OWNER'S AGENT/
EMPLOYEE CONSTRUCTION AUTHORIZATION AFFIDAVIT City of Fort Collins
(PLEASE PRIM)
I/We, 2eawe r , as owner(s) of record of the property
located at: /23 1Q. eo &� :S,,; 3.Sa Fort Collins, Colorado, hereby declare and attest
to the following:
❑ 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
Q I/we do authorize A<A— , (Agent) to act on
my/our behalf for the purposes of obtaining a building permit for minor alterations to the building
referenced above. Said Agent will be personally performing all of the work as described on permit/app
# 8079714I/we understand that the Agent naabove 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.
epaving read PPM 57 and understand the limitations therein.
Owner Owner
>r5 I2-7a 1_LL,
STATE OF COLORADO ) Agent
)ss.
COUNTY OF LARIMER )
i•he roregoing,Affidavit was acknowledged before me this day of a�&"
< Tr
Witness ray hand -and official seal.
My Comm;ssion'expires: gbj 4010
Public