HomeMy WebLinkAbout2830 Balmoral Dr - Affidavits/Owner Agent - 04/04/2011City 0f Planning, Development and Transportation
?O Box 580
ort Collins 281_ N College Ave
Ft Collins, CO 80524
970'22.1-6760 phone 970-224-6134fax
1/we, A �� !� , as owner(s) of record of the property located
At: CN 3 0 BA LM0/lA-L- m l Cie , Fort Collins, 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 thepast24-month period.
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. 1 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 c n tr ct' f ove referenced home, which is described more fully
on Permit Application # (obtained from Building and Zoning office). I/we
understand that any person (s or agents) contracted & 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.
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 in the pre ence of Notary Public
Owner
Co-owner
The foregoing Affidavit was acknowledged before me on this `t day of
A [ ( I (month, year) by `(ELK, tv 1 Y) co.. Y- a�w
Witness my hand and official
My commission expires: • MICMEip
SE L
OF C0�
e
MY COMMISSION'EXPIRES:
April 15j 2012 No ary Publi