HomeMy WebLinkAbout5144 Cinquefoil Ln - Affidavits/Homeowner - 08/13/2010City of Planning, Development. and Transportation
For` CollinPO Box 580
s 281 N Cotlege Ave
Ft Collins, CO 80524
970 221-6760 phone 970-224-6134fax
I/we, na +_&Y "Y and , as owner(s) of record of the property located
At: 51/ (4 Ci nque-fo; I Lqne , Fort Collins, Colorado, hereby declare and attest
to the following: (please check only the one that applies)
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 nay other new homes in the Fort Collins
city limits within the past 24-month period.
1 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.
❑ 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 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 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 persor�l(s�) orja; e t�s)ctracte orform structural wood framing, plumbing, HVAC,
electrical work, roofing or cast-in-place'structuraco lCrete 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 withthe 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 Public
Owner
Co-owner
The foregoing Affidavit was acknowledged before me on this /34h day of
kc)+ �(� (� (month, year) by lh4 r J
X Woos.
Witness my hand and official seal r;`�,•• • .O(i
NOTARY '
My commission expires: - ry-
'Notary Public