HomeMy WebLinkAbout544 Jansen Dr - Affidavits/Homeowner - 06/24/2010Cit,y� of 1004 ® 4 8 Planning Development and Transportation
E< 1 ` � Collins PO Box 58C
' 1 .7 281 N College Ave
Ft Collins CO 80524
970 221 6760 phone 970 224 6134 fax
Uwe T—(��as owner(s) of record of the property located
At `�Ij e 9 Fort Collins Colorado hereby declare and attest
to. the following (please check only the one that applies)
1 am/ we are acting on my/ our behalf for the purpose of obtaining a building permit and personally
constructing my/our home The nome to be constructed is on the above property and will be my/oar
primary residence Vwe have not personally cons rutted nay other new homes in the Fart Collins
city limits within the past 24-month period
I atn/we are acting on my/our behalf for the purpose of obtaining a �uildtng 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
❑ 1 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 house
to be altered is my/our personal residence I am aware that VNe cannot do any structural
electncal plumbing ore mechanical work and must hire contractors/subcontractors who are
currently licensed and irsures with the City of Fort Collins
I arihNe 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) Vwe
understand that any person(s) or agent(s) contracted to perform structural wood framing plumbing HVAC
electrical work roofing or cast m-place structural concrete work MUST BE licensed contractors in
accordance with the regulation or the City of Fort Collins
Vwe 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 preserce of Notary PubAc
Owner
Co-owner
The foregoing Af•idavrt was ackrcwledged before me on this Y' day of
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