HomeMy WebLinkAbout520 Sedgwick Dr - Affidavits/Homeowner - 12/14/2010City`CrF. Ptanning, Qevetopment.and Transcortaticn
0l l # ns Fa Box 53Q _
Ft Catlins; CO 805Z4
970-2711-6760 phone 970=124-6134 fax
U+Ne, c as cwrer(s) of record'cf tf*,e preper�l located
A: S �AGcJiC1e 'D ti t V+2 Fart Caflins,_G:taradc;. hereey dec!are and attest
tc: the fokwing: (pfegse c:7ecc oriy the one thcc GCpfies) -
G 1 aril we are acting on my/ our behalf for the purpose of cbt�inirg a building, ernnit and personally
construcing my/cur home. The home to be cbrstructad is cn' the ab'6 ve
property and wili'be niy/cur
primarl residence. L,Ne have not,perscnatiy ccnstruc4ed nay other new homes in the Fort Ccilins
cite Iirr�is wfthin `the past 24-marfit pencil:
'f arrAve are acting on mylour behalf_ far the purpose of abta(rfrig a bur7dirg permit' and Ferscnafly
constructing an alteration or addition to my/cur house. T ne house to be altered is on the above
property and, is my/cur personal residence.
❑ l ain%Ne are actfrg, on my./eu,r be .aii"fci ifie-purpose of cbtairing a"building, permit and perscraliy
canstr�cfirg a non-structural alteration to rry/cur attacfiert single_#amiiy.. dwelling unit: T'ne house
to be'aftered is my/cur peracrial residence- I an, awara.that I/we caiiitot do any struaural,
electrical, plumbing ere mec" 'cJa ': r and must hire cortr:.c`.crslsut;ccrtractcrs who are
currently licensed and irsures with the City of Fort Collin.
f ar,-LANe are personally perfc.r,-rkg all of a wcr'+c, or will be Continuously. supervising un aid .volunteer.
The A(Ce< fs :directly ref d to she ccns`suc�.lc6cfl ve refernced home, which is described more fully
on Permit ficaticn ,: U 1 d
AptJ, a (obtained from Building and Zoning ofnes), fhNe
undersfard that any peron(s) or agent(s) contracted to perform Structural wcc� framing, plumbing, HN.4C,
e(ec+.rca! w, er ,-.idcfieigb cast-in-pfade.strsctural ccricrete wcrlt, M US7Ec licersed cartractors it
accordancs" wfih `the re-Lfaticn of the City of For', Ccilins.
we under#and that failure t.c comply with any of the active conditions may resuft it revocation of any
permits associated with the above Fermit Appifcakn number, fcneiture of any fees that have been
collected, a.Stoe Work Order and a court sum'mens: -
S+gn ,h lie pri?serts cter� Public _ ' -
Cwr er Cc cwrer.
The foregoing Atildavft w,s ackncwledged before me on this day of
a�lq(mcnth year) by - `0- f,
V%t; ess my hand and official sect �OZ/Mtj s
\E00v bj,) ao'o -
Mh/ c i7lC:issicn express:
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