HomeMy WebLinkAbout4318 New Bedford Dr - Affidavits/Homeowner - 06/16/2006Community Planning and Environmental Services
Building and Zoning Department
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HOMEQWNER1BUILD ER AFFIDAVIT
City of Fort Collins 1
I/we, ��.�,c_ Tl as owner(s) of record of the property
(please print)
at: q 3l y gcv 04—M- el Dr , Fort Collins, Colorado, hereby declare and
(please print)
the following: (please check A, B or C, whichever applies)
located
attest to
❑ 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 our personal residence. I am aware that I/we cannot do any
structural, electrical, plumbing or mechanical work. I/w.re 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 th onstr ction f tie aOove referenced home, which is described more
fully on Permit Application # �%J (obtained from Building and Zoning
Office). I/we understand that an 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 presence of a NotaryPublic
Owner Owner
The foregoing Affidavit was ad4owledged before me on this RO day of .
e€,f��th, year)by fig C11c { 4-
Witness my hand and 9ff 00R.Rk _
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My commission exp�es: •'•.. Puboo .. a
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OF Gov \\\`\
00'nmissionEx4"'2 Notary Public
281 North College Avenue • P.O. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6760 - FAx (970) 224-6134