HomeMy WebLinkAbout440 Circle Dr - Affidavits/Owner Authorization - 03/08/2016City of
F6rt Collins
AFFIDAVIT
(as required by Section 4e7(D)(3), Section 4e8(D)(3)
or Section 4a9(D)(3) of the Fort Collins Land Use Cade)
I/we, `: 0 n{° s �.��- /L i b v. r c� � � i7�iz r� c• nn , as owner(s) of record of the property located
at: yg t_ [,,- ")c , Fort Collins, Colorado, hereby declare and attest
to the following: (please check only the one that applies)
am/ we are acting on my/ our behalf for the purpose of obtaining a building permit for a new,
detached accessory building to be constructed at the above -listed property. The building will be
constructed with water and/or sewer service. By signing this affidavit, I/we declare that the building
will not be used as a dwelling unit.
❑ I am/ we are acting on my/ our behalf for the purpose of obtaining a building permit for an alteration
to an existing, detached accessory building located at the above -listed property. The alteration
includes adding water and/or sewer service to the existing building. By signing this affidavit, I/we
declare that the building will not be used as a dwelling unit.
/we understand that using the building as a dwelling unit without approval from the City of Fort Collins will
be a violation of the Fort Collins Land Use Code and could result in a court summons.
Sign in the presence of Notary Public, record the document with the Larimer County Clerk and Recorder, and submit a copy of the
recorded document with the building permit for the work checked above.
Owner , -owner
The foregoing Affidavit was acknowledged before me on this ZS day of
%l 4 f L1 (month, year) by Co2K S ,��+�,•.,
Witness my hand and official seal
My commission expires: i'*-)%(_. Z,�I Z,:)% $
CORY SCOTT EICHLIN
Notary Public
State of Colorado
Notary ID 20144048332
My Commission Expires Dec 23, 2018
. c, , c�- LIU,
Notary Public