HomeMy WebLinkAbout7204 Laramie River Dr - Affidavits/Homeowner - 10/28/2011Cit''of
F®fit Collins
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66;
Planning Developmentcand Transportation
Po Box 580, i
281 N Cotlege Ave-
Ft1totlin's : G0 8052-4
970-221-6760 phone 970-224-6134fax
as owner(s) of record' -of the property located'
At: *7.,oqL¢rQj in z6i1w_ Aqi&-e Fort Collins, Colorado, hereby declare and attest
to the following: (please check only the one that applies)
❑ Lain/ - 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 andwill .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 rri our behalf jor the purpose of obtalrnng:a building permit and, personally
constructing an alteration or addition to my/our house. The house to be altered is the above
property and is my/our personal residence.
13 I,am/wd are acting on my/our-behalf for the purpose'of Iobtaining% a building,permit:and personally
?'constructing a°non=structural-aiferation to my/our"attached smgle'family'tlwellirig u-hit 'Th6 ffb6se
to be altered is my/o.ur personal residence. I am aware that I/we'canri"ofdo 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 supervisingunpaid volunteers.
The work is directly related to con ycx' of he above referenced home; which is described"more fully
on Permit Application # AA "1 (obtained from Building and Zoning office). Uwe
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
1iI iU TV IU1 OIG IGVUIQUVlI VI UIQ V]Ly u1 I Vll VVII II IJ.
I/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 i ` e resenc of otary Public
caner o-own
Th regoing Affidavit was acknowledged before me on this day of
(month, year) by i S
Witness my hand and official seal
My commission expires:
K MMBERLY B. RY7M,
Notary PubFF State of Colo
MY COmmission Expires September 26, 2W
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