HomeMy WebLinkAbout428 REMINGTON ST - AFFIDAVITS - 2/27/20090
mmeri k� s_ervices
3uilding and Zoning Department
BUILDING OWNER /AGENT AFFIDAVIT
R090107
xl/welf . (7),:J m. o' -�'OV , as owner(s) of record of the property located
SIC at Fort Collins, Colorado, hereby declare and attest to the following:
(please check the box that applies)
0 I am/we are acting on my/our behalf for the purpose of obtaining a building permit for minor alterations to the
building referenced above. 1 am/we are personally performing all of the work as allowed by City of Fort Collins
code and as approved on permit # . I understand that all work related to electrical,
plumbing, HVAC, gas piping and fire extinguishing systems must be performed by a City of Fort Collins
licensed subcontractor and that this work cannot commence until the City of Fort Collins Building & Zoning
department is notified of the subcontractor.
I/we am/are personally acting as the General Contractor for the purpose of obtaining building permit.
/ # for minor alterations to the building referenced above. I know that the labor, material
and profit of the permit cannot exceed $5,000. 1 understand that all work related to electrical, plumbing,
HVAC, gas piping and fire extinguishing systems must be performed -by a City of Fort Collins licensed
subcontractor and that this work cannot commence until the City of Fort Collins Building & Zoning department is
notified of the subcontractor.
0 Uwe do authorize -. (Agent) to act on my/our behalf for the purpose of
obtaining a building permit for minor alterations (no structural alterations) to the building referenced above.
Said agent will be personally performing all of the work as approved on permit # I
understand that all work related to electrical, plumbing, HVAC, gas piping and fire extinguishing systems
must performed by a City of Fort Collins licensed subcontractor and that this work cannot.commence until the
City of Fort Collins Building & Zoning department is notified of the subcontractor.
Uwe understand that the Agent named above is not a contractor and is my/our employee as defined by Colorado
law; or is acting on my/our behalf without any fee, compensation, or trade in -kind for the above work.
Further, I/we understand that payment of such fees or compensation for the above work, to any person who is not
in my/our employ as described by Colorado law, constitutes a "construction contract" and violates the Contractor
License provisions of the Fort Collins Code and will result in revocation of the above permit, forfeiture of fees and
a court summons.
Sign in the presence of a Notary Public
Owner Owner
1",4 f®r, ) A, A 4�
Agent
this day of (m ogn t h, year)
The
by_
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was ckno lec 1pli�efore
Witness my hand and official seal
My commission expires
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Paoy
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�1. Notary Pub'