HomeMy WebLinkAbout704 Mathews St - Affidavits/Homeowner - 09/27/2005Community Planning and Environmental Services
Building and Zoning Department
HOMEOWNER/BUILDER AFFIDAVIT
City of Fort Collins
I/we, r�axj/-A, A-�,C�ecso-\, , as owner(s) of record of the property located
(please print)
at:? o ti !: � ,, St— , 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 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. I/we 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 e referenced home, which is described more
fully on Permit Applicationh tti (obtained from Building and Zoning
Office). I/we understand that any persons or ag n o 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 of a Notary Public
Owner Owner
,
T e foregoin Affidavit was acknowledged before me on this Vtday of
(month, year)by r7k'-I� > -
Witness my hand and official seal
My commission expires:
My Commission Expires
11/12/2006
281 North College Avenue - P.O. Box 580 - Fort Collins, CO
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- (970) 221-67"60 - FAX (970) 224-6134