HomeMy WebLinkAbout3179 Twin Heron Ct - Affidavits/Homeowner - 07/15/2011Community Planning and Environmental Services
Building, and Zoning Department
BUILDING OWNER /AGENT AFFIDAVIT
-64
i fivi n
UwgQ , as owners) of record of the property located
ate (? Fort. Collins, Colorado, hereby declare and attest to the following:
(please check the box tliat.apPOes)
0 I am/we are acting on my/our behalf for the purpose of obtaining a building permit for minor alterations to the
building referenced above. I amlwe are personally performing all of the work as allowed by City of Fort Collins
code and as approved on permit # 1 understand that all work related to electrical,
plumbing, HVAC, gas piping and fire extinguishing systems must be performed by a City of Fort Collins
licensed subcontractor and that this .work cannot commence until the City of Fort Collins Building & Zoning
department is notified of the subcontractor.
I/we am/are personally acting as the General Contractor for the purpose of obtaining building permit
# for minor alterations to the building referenced above. 1 know that the labor, material
and profit of the permit cannot exceed $5,000. 1 understand that all work related to electrical; plumbing,
HVAC, gas piping and.,fire extinguishing`systems must be performed by a City of Fort Collins licensed
subcontractor and that this work cannot commence until the City of Fort Collins Building & Zoning department is
notified of the subcontractor.
Itwe do authorize - (Agent) to act on my/our behalf for the purpose of
obtaining a building permit for m!nor alterations (no structural alterations) to the building referenced above. 1
Said agent -will be personally performing all of the work as approved on permit #
understand that all work related to electrical, plumbing, HVAC, gas piping and fire extinguishing systems
must performed by a' City of Fort Collins licensed subcontractor and that this work cannot commence until the
City of Fort Collins ,Building & Zoning department is notified of the subcontractor.
l/we understand that the Agent named above is nofia contractor and is my/our employee as defined by Colorado
law; or is acting on my/our behalf without any fee, compensation, or trade in -kind for the above work.
Further, I/we understand that payment of such fees or compensation for the above work, to any person who is not
in my/our employ as described by Colorado law, constitutes a "construction contract" and violates the Contractor
License provisions of the Fort Collins Code and will -result in revocation of the. above permit, forfeiture of fees and
a court summons.
Sign in the presence of a Notary Pubec
ojw-
Owner - - Owner
Agent
The f e going Affidavit vyas a no le ged before me on this day of tz (month, year)
by
,,see* l
Witness
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My com sson expires:
a 4otaryPublic