HomeMy WebLinkAbout4918 SWITCHGRASS CT - MISCELLANEOUS - 2/2/2001Building & Zoning Dept. Fort CoCnls,Colorado 805 2-058080
Community Planning and Environmental Services Phone: 970 21 6760 FAX: 970 224 6134
BUILDING OWNER OR BUILDING OWNER'S AGENT/
EMPLOYEE CONSTRUCTION AUTHORIZATION AFFIDAVITS of Fort Coliifns
(PLEASE PRINT
I/We, i �T /—/ —� as owner(s) of record of the property
located at: �i d' S'r. �i T c'� �^-� sj� Fort Collins, Colorado, hereby declare and attest
to the following:
Q/f'am/we are acting on my/our behalf for the purpose of obtaining a building permit for minor alterations
to the building refIreWeJaV hv7p
ersonally performing all of the work as described on
permit/app #
❑ I/we do authorize , (Agent) to act on
my/our behalf for the purposes of obtaining a building permit for minor alterations to the building
referenced above. Said Agent will be personally performing all of the work as described on permit/app
I/we 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 my/our employee as prescribed 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.
I/we acknowladg a iniglead PPM 57 and understand the limitations therein.
'
er Owner
STATE OF COLORADO )
)SS.
COUNTY OF LARIMER )
The foregoing)
19_, by (0T�
Agent
was acknowledged before me this,,day of C
Witness my hand and official seal.
My Commission expires:
My Commission Expires November 10, 2002.E
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