HomeMy WebLinkAbout646 Stover St - Affidavits/Homeowner - 06/08/20111-6
p ' Planningm , Developent and Transportation
®���� PO Box,..580
281 N Cotlegt Ave"
O 25r.:G Ft Collins, CO 80524
970421 6760 phone 970-224-6134 fax
/we, brl�l ✓1A4 ( J , . E'Y ;.:..< .
cc �. , as owner(s) of eecord'of the property located
At: 6 V ve r S � , Fort Collins, Colorado, hereby declare and attest
to the following: (please check only the one that applies)
El F.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 ab' e-property.and will be myLou'r
primary residence. I/we have not personally constructed nay other new homes in the Fort Collins
city,limits within the .,past .24-month period::
I am/we are acting on my/our behalf forjhe purpose of. obtaining a ;building. permit and, personally .
constructing an alteration or addition to my/our house. The house to be altered is on the above
property and is my/our personal residence. ,
O I am/wed'are acting on my/our behalf for the purpose bf'obtaihing .a building permit and personally
constructing anon=structural alteration to my/our attached single
'family dwelling unit: The house
to be altered is my/our personal residence. I am aware that Irwe cannot do''any structural;
electrical, plumbing:ore mechahical work'and''must hire, contractors/subcontractors who-ar-e
currently licensed and insures 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 # (obtained from Building and Zoning office). I/we
understand that any person(s) or agent(s) contracted to perform.structural wood -framing, plumbing, HVAC,
_ _electrical work,_roof�ng or:_cast-in-place structural__concrete_work,_.MUST-BE_licensed contractors -in..---- -.- --- -=----.-- ----
/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 Word Order and a court summons.
Sign in the presence of Notar/ Public
Co-owner
11"
The foregoing Affidavit was acknowledged before me on this S day of
(month, year) by /�,��1 � 4
seal
My
'17a�All
Notary Public