HomeMy WebLinkAbout1300 Redwood St - Affidavits/Homeowner - 03/11/2011City,of.Planning, Development and Transportation
��_ . PO Box. 580
��g w
�1 C®ili�ish � l�� 281 N College Ave .
Ft Col.lin'sl, CO 80524
9.70-221,.-6760 phone 970-224-6134 fax
I/we, as owner(s) of record`of the property located
At: �L�w�� �� , 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.
I am/we are acting on my/our behalf forthe purpose of,obtaining 4. 4ilding 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 atn/we"are acting ur on my/obehalf for the purpose of obtaining a building permit and personally
constructing anon=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.
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 person(s) or agent(s) 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 -f the City`of Forl 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 f Notary Public
Owner U Co-owner
TheforegoingAffidavit was acknowledged before me on this da of
(month, year) by G�w
Witness m �;fi seal
�O .�,t lk Y ' •.•
My comibi1 expires:
1.*0
Notary Public