HomeMy WebLinkAbout721 Glenloch Dr - Affidavits/Homeowner - 07/09/2010Ciof
Fort Collins
I/we �- L� LF Gnu-,
Planning Development and Transportation
PO Box 580
281 N College Ave
Ft Collins CO 80524
970 221 6760 phone 970 224 6134 fax
as owner(s) of record of the property located
At 7 Zl %LEN 1-00A Tiy- FortCollins 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 home to be constructed is on the above property and will be my/our
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 for the 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
❑ 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 house
to be altered is my/our personal residence I am aware that I/we cannot do any structural
electrical plumbing ore mechanical work and must hire contractors/subcontractors who are
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 direct) t o tK ti the above referenced home which is described more fully
Y
on Permit Applicati (obtained from Building and Zoning office) I/we
understand that any person(s) or agent 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
/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 Notary Pubhc
ne7 fx
Co owner
The foregoing Affidavit was acknowledged before Ime on this _9 day of
(month year) by T( aJ Qh II hyrt"
Witness my hand and official
My commission expires U4e
Nota Public
M My COMMISSION EXPIRES i,ry
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