HomeMy WebLinkAbout430 Edwards St - Affidavits/Homeowner - 09/15/2010'3City of / v6 v �C:;)' Planning Development and Transportation
�Or} Collins Box 580 28
w ` 281 N College Ave
Ft Collins CO 80524
970 221 6760 pnone 970 224 6134 fix
Uwe 0--7 lZlz C' C/! 1 as owners) of record or the property located
At `f 3 s Fort Collins, Colorado hereby declare and attes,
to the following (please check orly the one ,hat applies)
1 am/ we are actirg on my/ our behalf for the purpose of obtaining a building permit and personally
constructing my/our home The home to be construcred is on the above property and will be my/our
primary residence I/we have not personally const Listed nay other new nomes in the Fort Coilins
city limits within he past 24-month period
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 house The house to be altered is on the above
property and is my/our personal residence
❑ 1 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 house
to be altered is my/our personal residence I am aware that Uwe cannot do any structural
electrical plumbing ore mechanical work and must hire contractors/subcontractors who are
currently licensed and insures with the City of Fort Collins
I an, 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 Apprication # (obtained from Building and Zoning office) Uwe
understand that any person(s) or agent(s) contracted to perform structural wood framing plumbing HVAC
electrical work roofing or cast -in -place structural concrete work MUST BE licersed contractors in
accordance with the regulation or the City of Fort Collins
Uwe 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 se rt a of Notary Pub
r
Co owner
The foregoing Affidavit was acknowledged before me o this day of
C (month year) by
Witness my hand i11dr�l, fd
tvly commissioA expires ` j
`Y0'it N
:o
Cr
�6rf
2 10N,
U
b
k0
_e /evoll
Notary Publ c