HomeMy WebLinkAbout418 W OLIVE ST - MISCELLANEOUS - 1/1/2000Building &Zoning Dept
community Planning and Environmental Services
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281 N. College Avenue, P.O. Box 580
0580
Fort Collins80
, Colorado FA)2-97o 224 6134
phone: 970 2216760
HOME OWNER -BUILDER AFFIDAVIT
(pi_EASE PRINT)
7
;� � (, as owner(s) of record of the Property
IIWe, C L- l C ' �� Fort Collins, Colorado, hereby declare and attest
Lti
located at:
to the following: a building permit for the construction
. I am/we are acting on my
Lour behalf for the purpose of obtaining ro ert and
or alteralt ion of my/our home. The home to be constructed or altered is on the above p P
is my/our personal residence. volunteers or to ees" (see
are personally performing all of the work, or supervis9elateddto the construct on of the above-
2, I amlwe P with any of the work(obtain from
pPM 58 attached) who might be assisting on permit Application No.
referenced home, which is described more fully
& Zoning Office). period.
Building other new home within the past 12-month
llwe have not personally constructed any lumbing, HVAC,
3 perform structural framing, p regulations of Fort
4, l/we understand that any persons or agents contracted to
electr
ical work, or roofing, MUST BE licensed contractors in accordance with the reg
Collins. I with any of the a ve nditions may result in revocation of any
understand that failure to comply . , 1_:.. of anv fees that have been
5. Ilwe Application I
permits associated with the above App
collected.
Owner ;
STATE OF COLORAOO )
)SS.
COUNT`( OF LARIMER )
� -- � day of
oin Affidavit was} acknowledged before me this
The foreg 9
- c
by
Witness my hand and official
My Commission expires:
MycommobnExE WNovel10,2002
C
Notary ublic