HomeMy WebLinkAbout901 EDWARDS ST - AFFIDAVITS - 12/10/2012Fort Collins
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1 HOMEO
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Planning, Development and Transportaden
PC) Box p0
L81 M CoUa e Ave
Ft l.e;lOV ins, CO JL—
970-221-6760 phone 970-224-6i34 fax
ER AFFIDAVIT
I/w,e,4� a s �,�� �'� , as owner(s) of record of the property located
At: /i/�f�S 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/we have not personally constructed nay other new homes in the Fort Collins
city limits within the past 24-month period.
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.
— l-am/we-arePersonallY Performin 'all of -the -work -,-or willbe-continuously -supervising -unaid-volunteers—
The work is directly related to the construction of the above referenced home, which is described more fully
on Permit Application O �btained from Building and Zoning office). I/we
understand that any p r n( ) o get ) ntr� cted: pd'rf)rm structural wood framing, plumbing, HVAC,
electrical work, roofin c i c tr ctur ret64ork, 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.
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The foregoing Affidavit was acknowledged before me on this �d / day of
.{month,
Witness my hand and official seal
My commission expires
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Notary Public