HomeMy WebLinkAbout913 BENSON LN - AFFIDAVITS - 10/3/2002nMm.,,inrvetl7�111rmm�ie�rt+•rnyA�/MPUI� H L1' M E
L' fi�%ctf ] t1r't C�tl.l_irts OWNER/BUILDER AFFIDAVIT
tl5L1}S1Y(1dT�m�mM•.eannn�ir.._„ mrrc•nr,�ppp�.�,L,
as ovvrler(s)
(I,lease prurt) of record of the properly located
at:-----b-1- ` r' yl C�r�
— A Fort Collins, Colorado hereby declare and attest to
(please print)
the following: (please check either, or S)
❑ 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 constructed any other- new home in Fort Collins city limits within the past 24-month period.
6. 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.
I am/we are personally performing all of the work, or will be continuously supervising unpaid volunteers.
The work is directly related t r i of he e referenced home, which is described more
fully on Permit Application � +�� d i bt oanefrom Building �
Office). I/we understand that an ( ding and Zoning
y persons or agents contracted to perform structural wood -framing,
plumbing, HVAC, electrical work, roofing or cast -in -place structural concrete work, MUST SE 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.
Sign in fhe presence a N ry Public
Owner Owner
The foregoing Affidavit was acknowledged before me on this �va
day of.
2—month, year)by . LDctt.��
Witness my hand and official seal
1'1y commission expires;
My Conniission Expires
06128t2006
Votary Public
"'] CC iVCl1L1E P:J. Bo., 5r.0 Fort Co]lirrs, CCU
L oJJO (97 U) -221-L760 ` F_-_�; I970' 14-6134