HomeMy WebLinkAbout205 3rd St - Affidavits/Homeowner - 05/22/2001Building &Zoning Dept. 281 N. College Avenue, P.O. Box 580
Community Planning and Environmental Services Fort Collins, Colorado 80522-0580 x=
Phone: 970 221 6760 FAX: 970 224 6134 � e'
HOME OWNER -BUILDER AFFIDAVIT
c <�Tz.rt (:Ojlins
(PLEASE PRINK
I/We,
located at:
as owner(s) of record of the property
to the following: Fort Collins, Colorado, hereby declare and attest
1 • 1 am/we are acting on my/our behalf for the purpose of obtaining a building permit for the construction
or alteraltion 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 App{' t' yo.
Building & Zoning Office). 6l 1 �104in from
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
STATE OF COLORADO
COUNTY OF LARIss.
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The oklg AffI hvi acknowledged before me this �Z
by rtrL� lir_z daYo a po!
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�� lal seal.
My Co
MY Conrtftm Expires 01.&W
Notary Pub is