HomeMy WebLinkAbout640 PETERSON ST - AFFIDAVITS - 3/20/2014z'r�i'..C'y. ✓- r "]�'� `a..•L�.a -'�' ." '. �: '�. .... i� ♦.T A"l l i. ,•ii J`1 SR..Y �..la
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DAVIT" r
I/we,Ti bRu�ft� as owners) of record of the property located
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At Mo QE s Sf , 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 my/our
and will be
primary residence. I/we have not personally constructed nay other new homes in the Fort Collins
city limits within the past 24-month period.
❑ 1 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 rn&urpersonal residence.
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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 farii ly `dwelling unit. The house
to be altered is my/our personal residence I am aware that I/vre cam downy'st uciural,
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 Mlbe 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 f (obtameditorn 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.
%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 0rder'and'a court s°ummons:
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Sign in the presence
�offNotary Public
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Owner Co-owner
The foregoing Affidavit was acknowledged before me on is Cam' day of
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L+ . -. r��1`� (month, year) by
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Alitness my hand and official seal
MARGARET R. CLANCY
- - - NOTARY PUBLIC
Ay commission expires. STATE OF COLORADO
i` NOTARY ID # 20134040425
MY COMMISSION EXPIRES AUGUST OS, 2017
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