HomeMy WebLinkAbout1214 W Mulberry St - Affidavits/Homeowner - 10/21/2011CP�hj$Of Planning, Developmentand Transportation
�Y IL RO Box,5801.
�®llins
rr . nr 281 N Coliege Ave
Ft Collins,. C0 80524
970-221-6' 66 !Phone 970-224-6134 fax
I/we, as owner(s) of record'of the properly iocafed
At: , S i Fort Collins, Colorado, hereby declare and attest
to the following: (please check only the one that applies)
.I arn/ 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 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.
❑ f am/we"are acting on my/our behalf for the purpose 'of'obtain ing a building permit and personally
constructing a non-structural alteration to my/our attached single family dwellingunit: The house
to be altered is my/our personal residence. I am aware that I/we canrof'do any structural; .
electrical, plumbing -ore mechanical t hire contractors/sub contra ctbrs' "who `are
currently licensed and insures with the City of Fort Collins.
am/we are per Ily erf I o t o o I be continuously supervising unpaid volunteers.
The work is dire eid t t ' i f a ve referenced home, which is described more fully
on Permit Applic (obtained from Building and Zoning office). I/we
understand that any person(s) or agent(s) contracted to perform. structural wood -framing, plumbing; HVAC,
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 ce Nctarl Public
Owner
Co-owner
The foregoing Affidavit was acknowledged before me on this day of
(month, year) by
—Le.
Witness my lal seal
Nty com , sipn•eIAP94
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