HomeMy WebLinkAbout912 PIONEER AVE - MISCELLANEOUS - 1/22/2001Building & 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)
INVe, C I/T,• , as owner(s) of record of the property
located at: /Z /PFort Collins, Color herebs, declare- �, hereby ..e,;,are and attest
to the following:
1. I am/we are acting on my/our behalf for the purpose of obtaining a building permit for the construction
or alteraltion of mylour 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 reculations of Fort
Coilir s-.
5. I/we understand that failure to comply with any of the above conditions may result in revocation of any
permits associated with the accve Application Number, and forfeiture of any fees that have been
collected.
wner
STATE OF COLORADO
)ss.
COUNTY OF LARIMER )
The foregoing Affidavit ,wa/s acknowledged before me this 1-� day
by (/11 � i <- H� -\ / r) A vLSdN
Witness my hand and official seal.
My Commission expires:
My Commission Expires November 10, 2002
Owner
IWA
/r�t/�/ IN