HomeMy WebLinkAbout2820 Longboat Way - Affidavits/Homeowner - 01/07/2004Community Planning and Environmental Services
Building and Zoning Department
HOMEOWNER/BUILDER AFFIDAVIT
Citv of Fort Collins
I/we, � /- �as owner(s) of record of the property located
p ase prin
at'I F Fort Collins, Colorado, hereby declare and attest to
(pleas print)
the following: (please check A, B or C, whichever applies)
❑ 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.
❑ C. I am/we are acting on my/our behalf for the purpose of obtaining a building permit and
personally constructing a non-structural alteration to my/our attached single family dwelling
unit. The home to be altered is our personal residence. I am aware that I/we cannot'do any
structural, electrical, plumbing or mechanical work and must hire contractors/subcontractors who
are currently licensed with the City of Fort Collins.
I am/we are personally performing all of the work, or will be continuously supervising unpaid volunteers.
The work is directly related tot constructs o th ab e referenced home, which is described more
fully on Permit Application # (obtained from Building and Zoning
Office). I/we understand that ja p son o agents con ratted 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 presence ofp Notary Public
Owner
Witness my hand and official seal
My commission expires:
MY Commission Expires
t 1/12/2006
Owner
Wedged before me n this � day of
(month, year)by �C1SChN C
7
6/
281 North College Avenue • P.O. Box 580 . Fort Collins, CO 80522-0580 • (970) 221-6760 • FAX (970) 224-6134