HomeMy WebLinkAbout4112 MOUNT VERNON CT - AFFIDAVITS - 11/19/2012Ci LV >✓i Planning, Development and Transportation
Collins Fort P� Box Sac
r^� 281 t`i LO'UeOP Ave
Fr Cottins, CO 8052e.
970-221-6760 phone 970-224-6114fax
HOMEOWNER AFFIDAVIT
I/we, �.A-vt 01 l t�i `cw �c l(1 as owner(s) of record of the property located
� yT At: 2 ' l • yz°vU t n GA • Fort Collins, Colorado, hereby declare and attest
to the following: (please check only the one that applies)
❑ 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/vue have not personally constructed nay other new homes in the Fort Collins
city limits within the past 24-month period.
ZX 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.
❑ 1 am/we are acting on my/our 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.
-1 1-am/we-are-personally performing -all of the work, -or will -be continuously supervising -unpaid-volunteers
The work is directly r. aleto'149t ctif tla e referenced home, which is described morefully
on Permit Applicati • (obtained from Building and Zoning office). I/we
understand that an rs r a t co racte to P rform structural wood -framing, plumbing, HVAC,
electrical work, roo mg or cast -in -place structural concrete work, MUST BE licensed contractors in
accordance with the regulation of the City of Fort Collins.
Uwe 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
—� , \
Owner
Co-owner
The foregoing Affidavit was acknowledged before me on this day of
No 0 e-it"3a jc (month, year) by v
Witness my hand and official seal
i! F '.0
My commission expires: �= .� • ,� . --.,
':.A^ �8 'f
itC
Notary Public