HomeMy WebLinkAbout600 10TH ST - AFFIDAVITS - 3/19/2002City of Fort Collins
Community Planning and Environmental Services
Building and Zoning Department
HOMEOWNER/BUILDER AFFIDAVIT
B020i285
I/we, I. ''.11 ', a 0--y C • , as owner(s) of record of the property located
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at: 600 D-fAjUk 5l , Fort Collins, Colorado, hereby declare and attest to
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the following: (please check all the boxes thatpertain to this particularpermio
❑ I am/ we are acting on my/our behalf for the purpose of obtaining a building permit for the
construction of 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 any other new home in 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 for the alteration
or addition to my/our home. The home to be altered is on the above property and is my/our
personal residence.
❑ I am/we are personally performing all of the work, or will be continuously supervising unpaid
volunteers or paid hourly workers other than those performing the trades listed below. The work
must be 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 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.
o 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.
Sign in the presenceofa Notary Public (Q� f�
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Owner Owner
Th foregoing Affidavit� was acknowledged before me on this ay o
v�fTp (month, year)by ,`
Witness my hand and official seal
My commission expires:
M,j Cc:: imr ssicn Expires Ncvembar 10, 202
Notary Public
281 North College Avenue • P.O. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6760• FAX (970) 224-6134