HomeMy WebLinkAbout901 EDWARDS ST - AFFIDAVITS - 9/19/2012City Of wl
� Ft Planning, Development.andTransportation
����¢ PO Box 580
` CoN College Ave
Ft Collins, CO 80524
970-221-6760 phone 970-224-6134 fax
At:
to the following: (please check only the one that applies)
as owner(s) of record of the property located
rt Collins, Colorado, hereby declare and attest
❑ 1 am/ we are acting on my/ our behalf for the purpose of obtaining a building permit and personally
constructing my/our home. The home to be constructed is on the above property and will be my/our
primary residence. I/we have not personally constructed nay other new homes in the Fort Collins
city limits within the past 24-month period.
I am/we are acting on my/our behalf for the purpose of obtaining a building permit and personally
constructing an alteration or addition to my/our house. The house to' be altered is on the above
property and is my/our personal residence.
❑ I am/we are acting on my/out behalf for the purpose of obtaining a building permit and personally
constructing a non-structural alteration to my/our attached single family dwelling unit. The house
to be altered is my/our personal residence. I am aware that I/we cannot do any structural,
electrical, plumbing ore mechanical work and must hire contractors/subcontractors who are
currently licensed and insures with the City of Fort Collins.
I am/we are personally performing all of the work, or will be continuously supervising unpaid volunteers. .
The work is directly related t he ons of the above referenced home, which is described more fully
on Permit Application # ` h�� ! (obtained from Building and Zoning office). Uwe
understand Thal any persons) or agents)contracted fo perform stroctiaral wood=framing, plumbing`, HVAC-----
electrical work, roofing or cast -in -place structural concrete work, MUST BE licensed contractors in
accordance with the regulation of the City of Fort Collins.
I/we understand that failure to comply with any of the above conditions may result in revocation of any
permits associated with the above Permit Application number, forfeiture of any fees that have been
collected, a Stop Word Order and a court summons.
Sign in the presence of Notary Public
wner Co-owner
The foregoing Affidavit was acknowledged before me on this day of
10 IZ (month, year) by
Witness my hand and official seal
My commission expires:
ALISON VAN DEUTEKOM
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID # 20114076097
MY COMMISSION EXPIRES DECEMBER 01, 2015
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Notary Public