HomeMy WebLinkAbout900 W PROSPECT RD - AFFIDAVITS - 4/3/2013[it./ of Planning, Deve!cpment and Transportation
PO Sox I80
.Fort Collins 281 i+ Coile_e 4ve
Ft ro;lins, CO $052
970-221-6760 phcne 970-721-6124 Fax
HOMEOWNER AFFIDAVIT
/we, / Sr I f4�y��C�l�{/� as owner(s) of record of the property located
At: �/00 L V, pko5/l Fort Collins, Colorado. herebv 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.
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.
I am/we are personally performing all of the work, or will be continuously supervising unpaid volunteers.
The work is directly related to the construction of the above referenced home, which is described more fully
on Permit Application # _(obtained_from Building and..Zoning.office).- I/we
understand that any person(s) or agent(s) contracted to perform structural 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 th7/1
(Not ry Pubtic
' ner
Co-owner
r�
^The foregoing Affidavit was acknowledged before me on this
2-0 G�> (month, year) by �Q ��' ""c�(3Y1
ALISON VAN DEUTEKOM
Witness my hand and official seal STA ETOF COLORARY IADO
NOTARY ID a 20114078087
F
mmismoN EXPIRES DECEMBER 011205
day of
My commission expires:
n
Notary Public
130146�
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