HomeMy WebLinkAbout906 Marble Dr - Affidavits/Homeowner - 04/29/2002City of Fort Collins
Community Planning and Environmental SerViCes
Builditig apid oriin;t Dep.artrten�
80202179
H0MEOWNER/ BUILDER AFFIDAVIT
I/we, �y+l �- , as owner(s) of record of the property located
(please i t)
at: ��(p MCI r�)t e b � , Fort Collins, Colorado, hereby declare and attest to
(please print)
th e fo I I owi n g : (please check all the boxes that pertain to this particular permit)
❑ I am/ we are acting on my/our behalf for the purpose of obtaining a building permit for the
construction of 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.
I am/we are acting on my/our behalf for the purpose of obtaining a building permit for the alteration
or addition to my/our home. The home to be altered is on the above property and is my/our
personal residence.
I am/we are personally performing all of the work, or will be continuously supervising unpaid
volunteers or paid hourly workers other than those performing the trades listed below. The work
must be 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.
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.
Sign in the pr en f a t ry Public
Own Owner
The f regoio Affidavit was acknowledged before me on this _day of
(month, year)by =
Witness my hand and official seal
My commission expires:
MY CoR+mission Expires November 10, 2CO2 \
Notary Public
281 North College Avenue • P.O. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6760 • FAX (970) 324-6134