HomeMy WebLinkAbout722 W Mountain Ave - Affidavits - 08/22/2002City' of Fort- Collins
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C on-imunity Plartlling and Environmental Se1-vices
L'txilding and Lonix,g Depalblient
HOMEOWNER/ BUILDER AFFIDAVIT
I/we, Aytdae-c= it V l e tz ,
(please print) ,
at: !, f t) . (/lets Vn�grvr�
(please print)
the following: (please check eithe)'A or B)
as owner(s) of record of the property located
Fort Collins, Colorado, hereby declare and attest to
❑ A. I am/ we are acting on my/our behalf for the purpose of obtaining a building permit and
personally constructing 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.
❑ B, 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 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.
The work is directly related to the co struction of the above referenced home, which is described more
fully on Permit Application # (obtained from Building and Zoning
Office). I/we understand that a p s+m Maent5co a ed 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, a Stop Work Order and a court summons.
Sign in the pregKnce1f a Notary Public
Owner
Owner
Thp,foregoing Affidavit was acknowledged before me�Qn- th* 4� dayDf
_ (month, year)by1�L1.Q
Witness my hand and official seal
My commission expires:
My Cmtsft Bores
osre 006
281 h?ort] College Avenue P.O- Bo;: 6S0 o Fort Collins, CO 80522-0580 • (970) 221-6760 • EAx (970) 224-6134