HomeMy WebLinkAbout4625 REGENCY DR - AFFIDAVITS - 7/29/2003and Environmental Services
Building and Zoning Department
HOMEOWNER/BUILDER AFFIDAVIT
9- F-d 3
City of Fort Collins
I/we, Loc4 �- as owner(s) of record of the property located
(please pant
at: 4-ro25� U , Fort Collins, Colorado, hereby declare and attest to
(please print)
the following: (please check A, B or C, whichever applies)
❑ 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.
❑ 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.
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. I/we must hire contractors/subcontractors who
are currently licensed with the City of Fort Collins.
I am/we are personally performing all of the work, or will be continuously supervising unpaid volunteers.
The work is 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"roo
s n c r ed to perform structural wood -framing,
plumbing, HVAC, electrical wong orcast-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 numberforfeiture of any fees that have been
collected, a Stop Work Order and a court summons. ,
Sign in the pr ence oiea Nibtary Public
t
0 ner Owner
The foregoinq Affidavit was acknowledged before me on this 1 d y of
(month, year)by log//i,[�
Witness my hand and official seal
My commission expires:
/- �3o-0?
281 North College Avenue • P.O. Box 380 • Fort Collins, CO 80522-0580 • (970) 221-6760 • FAX (970) 224-6134