HomeMy WebLinkAbout1518 Sam Houston Cir - Affidavits/Homeowner - 10/09/2008Community Planning and Environmental Services
Building Services
HOMEOWNER/BUILDER AFFIDAVIT
City of Fort Collins
I/we, t+ i, ne `�v as owner(s) of record of the property located
Please prin�)/
at Ps / rn PCs U �c%e , Fort Collins, Colorado, hereby declare and attest to
(please print)
the following (p/ease check A, B 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 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 personally performing all of the work, or will be continuously supervising unpaid volunteers
The work is directly related to o Lo94 jhe above referenced home, which is described more
fully on Permit Application # U IN I ZAI (obtained from Building and Zoning Office)
I/we understand that any pers ns 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 prese e of a Notary Public(
Owner Owner
Thg�oregoing Affidavit was acknowledged before me on this day of
UC����ae� o�C (month, year)by _Lr)CA I,S�e. Sus-7&)tj
Witness my hand and official
My commission expires i
MICHELLE Ls
MEIS = _
Notary Public
Co D I-
281 North College Avenue - PO EoX 580 Foit Collins CO 80y22 0680 (970) 221 6760 FAX (970) 224 6134