HomeMy WebLinkAbout612 PROUTY CT - AFFIDAVITS - 2/9/2009Community Planning -and Environmental Services
Building and Zoning Department
HOMEOWNER/BUILDER AFFIDAVIT
I/we, Z - 5jz'V.*14_ as owner(s) of record of the property located
(P se print)
at: Fort Collins, Colorado, hereby declare and attest to
(please pent)
the following: (plea5a check A, B or C, whichever app1ie5)
o A. I 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 constructedany other new home in Fort
Collins city limits within the past 24-m6nth period.
B. 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 home. The home. to be altered is on the
above property and. is my/our personal residence.
o C. I 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 home to be altered is our personal residence. I am aware that I/we cannot do any
structural, electrical, plumbing or mechanical work and must hire contractors/subcontractors who
are currently licensed with the City of Fort Collins.
I am/we are personally performirgLal f e r or ile e-ontinuously supervising unpaid volunteers
The work is directly related to th s • 'c o1 1e ab e referenced home, which is described more
fully on Permit'.Application, (obtained from Building and Zoning
.Office). I/we understand that any persons or agents 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 Work Order and a court summons
=5ign in the peese of a Notary Public
C
i
Owner
Owner
Th oregoing Affidavit was acknowledged before me n this oq day of
bnA aff)° (month, year)by orvv&cL,
Witness my hand and official
.My commission expires: .'n
€ MICHELLE L's,
MEIS
NotaryPu lic
W COMMISSION EXPIRES: (� ��-
281 North College Avenue - PO. x Fort Collins, CO 80522-0580 - (970) 221-6760 - FAX (970) 224-6134