HomeMy WebLinkAbout627 LESSER DR - AFFIDAVITS - 4/10/2002City of Fort Coffins
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I3:. ildi-;i- .`ii`d 1�4J3 1i!:' Departmetlt
HOMEOWNER/BUILDER AFFIDAVIT
I/we, 1_L0 U a5 Z Cow v-1- B 0 2 0 1 7® 2
as owner(s) of record of the property located
please print)
at: Z Le5:�er Fort Collins, Colorado, hereby declare and attest to
(please print)
the following: (please check all the boxes thatpertain to this particu/arpermit)
❑ 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.
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 presence of a Notary Public
ner Owner
he fore oing Affidavit was acknowledged before mejw this / 0 qVv day of�7
(month, year)by l!fng4ots ,�L4A,(&_5 ( DUP,=
Witness my hand and official seal
My commission expires: mbe t10,j
2.
281 North College Avenue • P.O. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6760 • FA), (970) 224-6134