HomeMy WebLinkAbout5827 Auburn Dr - Affidavits - 07/02/2001Building
& Zoning
Dept
281 N. oege Avenue, Box 80
.
Community Planning and Environmental Services
Fort Collns, Colorado 8 5202-0580
Phone: 970 221 6760 FAX: 970 224 6134
HOME OWNER -BUILDER AFFIDAVIT
Y((,PLEASE PRINT)
1/We
located at:
to the following:
AV-k
as owner(s) of record of the property
Fort Collins, Colorado, hereby declare and attest
I am/we are acting on my/our behalf for the purpose of obtaining a building permit for the construction
or alteraition of my/our home. The home to be constructed or altered is on the above property and
is my/our personal residence.
2. 1 am/we are personally performing all of the work, or supervising unpaid volunteers or "employees" (see
PPM 58 attached) who might be assisting with any of the work related to the construction of the above -
referenced home, which is described more fully on Permit Application No. (obtain from
Building & Zoning Office),
3, I/we have not personally constructed any other new home within the past 12-month period.
4. I/we understand that any persons or agents contracted to perform structural framing, plumbing, HVAC,
electrical work, or roofing, MUST BE licensed contractors in accordance with the regulations of Fort
Collins.
5. I/we understand that failure to comply with any of the above conditions may result in revocation of any
permits associated with the above Application Number, and forfeiture of any fees that have been
collected.
Owner
ST,
)SS.
COUNTY OF LARIMER )
The foregoing Affidavit was acknowledged before me this day of
byX P//l j67 2u)intC)
Witness my hand and official seal.
My Commission expires:
My Commission Expires November 10, 2002 v -