HomeMy WebLinkAbout4226 STONERIDGE DR - MISCELLANEOUS - 3/26/2002City of Fort Collins
Community Planning and Environmental Services
Building and Zoning Department
HOMEOWNER/BUILDER AFFIDAVIT
80201378
I/we, I�a.c�; �u,t,C,� (� as owner(s) of record of the property located
(please se print)
at: 422(� s-; Ltf� b-r- Fort Collins, Colorado, hereby declare and attest to
(please print)
the following: (please check all the boxes thatpertain to this particularpermit)
dam/ 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.
a,`1 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.
p✓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 # 3o zu l37 (obtained from Building and Zoning
Office).
o/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.
�/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 presence of a Notary Public
Owner
Owner
f regoin Aff avit was acknowledged before me n this day of
Z— (month, year)by
Witness my hand and official seal
My commission expires:
My CO -,mission Expires Nc vembar 10, 20: 2
Notary Public
,oi iNortn �-oiiege Avenue • vu. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6760 • FAX (970) 224-6134