HomeMy WebLinkAbout4351 GEMSTONE LN - AFFIDAVITS - 6/20/2001Building
&Zoning
Dept
281 N. College Avenue, P.O. Box 580
.
Fort Collins, Colorado 80522-0580
Community Planning and Environmental Services
Phone: 970 221 6760 FAX: 970 224 6134
HOME OWNER -BUILDER AFFIDAVIT
(PLEASE PRINT
I/We, 1 1 C KtJ en M I c r
l9 � JUN 2 5 2001
as owner(s) of record of the property
located at: '651 Gt'0 a h e La K.tt Fort Collins, Colorado, hereby declare and attest
to the following:
1. 1 am/we are acting on my/our behalf for the purpose of obtaining a building permit for the construction
or alteraltion of my/our home. The home to be constructed or altered is on the above property and
is my/our personal residence.
2. 1 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. (obtain from
Building & Zoning Office).
3, I/we have not personally constructed any other new home within the past 12-month period.
4. I/we 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 regulations of Fort
C�Z•71M,
5. I/we 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
n
Owner
STATE OF COLORADO ) 04MKMYAU 10
)sz Oft�i111r�0-�otrngt, b4!
COUNTY OF LARIMER ) *On i I anEvOw.413,=1
The foregoing Affidavit was acknowledged before me this �_g day of 4jt—iEre
by !i/�/
Witness my hand and official seal.
My Commission expires:
r
Notary R661ic