HomeMy WebLinkAbout1901 Bronson St - Affidavits/Homeowner - 09/08/2009Community Planning and. Environmental Services
Building and Zoning Department,
HOMEOWNER/ BUILDER AFFIDAVIT
City of Fort Collins
I/we, j Ju Al 61<f as owner(s), of record of the propertylocated
.(please rint) .
at: 1901 ron so h , Fort Collins, Colorado, hereby declare and attest to .
(please 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, ison 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 to the construction' of the above referenced home, which is described more
fully on Permit Application .# Q O 9057 Z SS (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/we understand that failure to comply withany 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 Notary Public
Owne
The foregoing Affidavit was acknowled before me on this D day of
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Witness my hand and official s I
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My commission expires: 9
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AUG.4 2012 Public
281 North College Avenue , P.O. Box 580 • Fort Collins, CO 80522-0580 . (970) 221-6760 • FAX (970) 224-6134