HomeMy WebLinkAbout4138 Cedargate Dr - Affidavits/Homeowner - 06/14/2004City of Fort Collins
Community
and Environmental Service
s
Building and Zoning Department
HOMEOWNER/BUILDER AFFIDAVIT
I/we, O J
,(pse print) as owner(s) of record of the property located
at:� c a G '� Fort Collins, Colorado, hereby declare and attest (Please rent)
the fol t t0
I (please checkA, 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 un
The work is directly related to the construction of the above referenced home, which is des Gibed mo es
fully on Permit Application #
Office). I/we understand that an (obtained from Building and Zoning
Plumbing, HVAC, electrical work, roofing or ocast-in-place nstructural ots contrcted toence a work structuM Iwood-framing,
contractors in accordance with the regulation of the City of Fort Collins. UST BE licensed
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 of a Nota Pub/ic
Owner
Owner
The foregoing Affidavit was acknowledged before me on this ( 4 _ . of 6044
Year)by
(month day of
i�i �
Witness my hand and official seal
My commission expires:
My Commission Expires
10122J2005
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