HomeMy WebLinkAbout1809 CHURCHILL CT - AFFIDAVITS - 3/19/2000ado/lG 36
Building &Zoning Dept. 281 N. College Avenue, P.O. Box 5ao
Fart Collins, Colorado 80522.05a0
Community Planning and Environmental Services Phone: 970 221 6760 FAX: 970 224 8134
6fA- a,
HOME OWNER -BUILDER AFFIDAVIT
(PLEASE PRIN-n
IM/e,
as owner(s) of record of the property
located at: CiF tJ t � �. Fort Collins, Colorado, hereby declare and attest
to the fallowing:ina:
1. I am/we are acting on my/our behalf for the purposz of obtaining a building permit for the Ccnst Liction
or alteraltion of mylour home. The home to be constructed or altered is on the above property and
is mylour personal residence.
2. i am/we are personally performing all of the work, or supervising unpaid volunteers or "employees" (see
PPM 58 attached) who might be assisting with any of the work related to the construction of the above -
referenced home, which is described more fully on Permit Application No. laao Obtain from
Building & Zoning Office).
3, Ywe have not personally constructed any other new home within the past 12-month period.
4. Uwe understand that any persons or agents contracted to perform structural framing, plumbing, HVAC,
electrical work, or roofing, MUST BE licensed contractors in accordance with the reculations of Fort
Collins.
5. Ilwe understand that failure to comply with any of the above conditions may result in revocation of any
permits associated with the above Application Number, and forfeiture of any fees that have been
collected.
STATE OF COLORADO )
)S5.
COUNTY OF LARIMER )
The for/eg Ing Aff davit w ac,�{kn/owle gel b fgre 7rie tt, i
by JG itlj'/X_iA LI/oC�.
Witness my hand and official seat. _— J,.
My Commission expires:
My Commission Expires November 10, 2002
Owner
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