HomeMy WebLinkAbout1031 Conifer St - Affidavits/Owner Agent - 06/10/2002Building & Zoning Dept . 281 N. College Avenue, P.O. Box 580
Fort Collins, Colorado 80522-0580
Community Planning and Environmental Services Phone: 970 2216760 FAX: 970 224 6134
BUILDING OWNER OR BUILDING OWNER'S AGENT/
EMPLOYEE CONSTRUCTION AUTHORIZATION AFFIDAVIT City of Fort Collins
(PLEASE PRINT)
ime, CA IV YQA0 CGnT 914 L L C T, L ?o. , as owner(s) of record of the property
located at: 10 i 1 C d N 1 F ER ST RcEr , Fort Collins, Colorado, hereby declare and attest
to the following:
❑ 1 am/we are acting on my/our behalf for the purpose of obtaining a building permit for minor alterations
to the building f o3rri�we personally performing all of the work as described on
permit/app #CT
1(,.
I/we do authorize —rOM tl C CALL , (Agent) to act on
my/our behalf for the purposes of obtaining a building permit for minor alterations to the building
referenced above. Said Agent will be personally performing all of the work as described on permit/app
I/we understand that the Agent named above is not a contractor and is my/our employee as defined by
Colorado law; or, is acting on my/our behalf without any fee, compensation, or trade in -kind for the
above work.
Further, I/we understand that payment of such fees or compensation for the above work, to any person
who is not my/our employee as prescribed by Colorado law, constitutes a "construction contract" and
violates the Contractor License provisions of the FortCollins Code, and will result in revocation of the
above permit.
I/we acknowledge having read PPM 57 and understand the limitations therein.
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• -
STATE OF COLORADO
COUNTY OF LARIMER
The fo
by —
)SS.
Owner
Agent
ng Affidavit was acknowledged before me this /�i day of Jc-� ne-
,
Witness my hand and official seal.
My Commission expires:
Notary Public