HomeMy WebLinkAbout1016 W Mountain Ave - Affidavits/Homeowner - 05/19/2017RECEPTION #20170034555, 5/26/2017 3:50:33 PM, I of a, 528.00
Angela Myers, Clerk & Recorder. Larimer County, CO
B17 ®2 67®
Fort Collins
AFFIDAVIT
(as required by Section 4.7(D)(3), Section 4.8(D)(3)
or Section 4.9(D)(3) of the Fort Collins Land Use Code)
I/we, tDaCu-/ I M_ �4(JI ✓e_ , as owner(s) of record of the property located
at: 101� (A) A aUa je) F} tlC 1 a�t 61r/tir J� 6ft#ort Collins, Colorado, hereby declare and attest
to the following: (please check only the one that applies)
W 1 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.
❑ 1 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, Uwe
declare that the building will not be used as a dwelling unit.
I/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,
recorded document with the building permit or the work checked above.
ner Co-owner
and submit a copy of the
The foregoing Affidavit was acknowledged before me on this o2 Ste' day of
Gt t, , 7011 (month, year) by
Witness my hand and official seal
My commission expires: C-Mwzo
otary Public
AYESHA EKANAYAKE
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID 20164017687
MY COMMISSION EXPIRES 05012020