HomeMy WebLinkAbout630 Blue Mesa Ave - Affidavits/Homeowner - 10/15/2002r>uuwwrnn�nxeo-Nru'I NG 1ATOWNERjBUILDERAFFIDAVIT
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(pl a; e print) as I
as ownerpros) of record of tl-,e pert � located
/✓C, Fort Collins, Colorado, Hereby declare and attest to
(please print)
the following: (p/ease Check eltherA orb)
❑ A. I am/ we are acting on my/our behalf for the purpose of obtaining a builcing permit and
Personally constructing my/our home. The hone to be constructed is on the above property and
will be myJour primary residence. I/we have not personally constructed any other new hon-ie in Fort Collins city limits within the past 24-month period.
.,V& 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 construction of the above referenced home, which is described more
fully on Permit Application #_ 15 D 2 a 3
� ? 3/(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 vve 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 prise ce of a Notary Public
4Own
Owner
The fore Tin Affidavit was acknowledged before me on this /Sf/j day of
_,M(IAWA6rti�y ear)by
Witness my hand and officisb1�i'%
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(970) 221-b'760 - F_-J•. ("970') 22-61:'-?