HomeMy WebLinkAbout2627 Redwing Rd - Affidavits - 07/13/20004 _
Building & Zoning Dept. For N. College Avenue, P.O. Box 580
Fort Collins, Colorado 50522-0580
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 Collfns
(PLEASE PRINT)
I/VNe, AA �k7I14 as owner(s) of record of the property
located at: 2 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 referenced above. I am/we are personally performing all of the work as described on
permit/app # ; or
k
I/we do authorize v WA r� E i J,.^ (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 Fort Collins Code, and will result in revocation of the
above permit.
I/we acknowledge having read PPM 57 and understand the limitations therein.
yL� �
Owner
STATE OF C�6CORADO )
)SS.
COUNTY OF LARiMER )
4 R
C.
Owner
i� et�ix LFez
Agent
The fore 'ng Affidavit was acknowledged before me this � day of
by
Witne s I hand and official 4eal.
My Commission expires:
Notary
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