HomeMy WebLinkAbout301 Edwards St - Affidavits/Homeowner - 02/26/2009Community Planning -and Environmental Services_ .s_ _ .
Building and Zoning Department
HOMEOWNER/BUILDER AFFIDAVIT
.�I/we, %�C "�E�—l- as owners) of record of the property located
'. lease print)
at:AMW��cI�2� S , Fort Collins, Colorado, hereby declare and attest to
(please print)
the following: (p/easa check A, B or C, whichever applies)
o 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.
o . 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 personally performing all of the work, or will be continuously supervising unpaid volunteers.
The work is directly related to the construction of the above referenced home, which is described more
fully on Permit'.Application. # (obtained from Building and Zoning
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.
J/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
caner
Owner
The foregoing Affidavit was acknowledged before me on this day of
,b✓Ltc�t �� (month, year
�CCk%- `�1 �aN2-ll
Witness my hand and
My commission expires: . MICHELLE .L
tt� MEIS
Notary Pu _ic
MY COMMISSION EXPIRES:
A , 15; 2012
281 North College Avenue - P.O. Box 580 - Fort Collins, CO 80522-0580 - (970) 221-6760'FAX (970) 224-6134