HomeMy WebLinkAbout3500 Plumstone Pl - Affidavits/Homeowner - 06/16/2006Community Planning and Environmental Services
Citv of Fort Collins
I/we, 6N t
Building and Zoning Department
HOMEOWNER/BUILDER AFFIDAVIT
iA;e—
as owner(s) of record of the property located
(please print)
at: 73 $ 4IN 0L--,, j► $Tv�,+G 00ce , Fort Collins, Colorado, hereby declare and attest to
(please print)
the following: (please checl(A, 6 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. n
"❑ 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/iAie must hire contractors/subcontractors who
are currently licensed with the City of Fort Collins.
I am/we are personally performing all th w k, r-will be continuously supervising unpaid volunteers.
The work is directly related to the con ti f o r r ced home, which is described more
full on Permit Application # btained from Building and Zoning
Y pP
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, forfeiture -of any fees that have been
collected, a Stop Work Order and a court summons.
Sign in resen f a N tary Public
Owner Owner
The foregoing ffidavit \ 4fiiaa4n/,owledged before on this day of
db nNcinth; year)by ) �b��2�� l`�y� Rp c�ti�-
Witness my harrP Q 6%dal sal 2
-n j.
My Commission' x i s,. 0 T
o Notary Public0
281 North College Avenue • P.O. Box 580 - Fort Collins, CO 80522-0580 • (970) 221-6760 • FAX (970) 224-6134