HomeMy WebLinkAbout1809 THYME CT - AFFIDAVITS - 12/18/2002Corani unity Planning and Environs-zental Services
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City of Fort Collins
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HOMEOWNER/BUILDER AFFIDAVIT
I/we, "1/'Q/ ///,'/ . aS nwnPr(s) of rprnrrl of thA nrnnc r+„ [r,,�+-ori
(pease print)
at:_ /�fU> /;e,, 6/ , Fort Collins, Colorado, hereby declare and attest to
(please print)
the following: (please check either A or ,5)
❑ 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.
YB. 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 to u 'o a o eferenced home, which is described more
An
fully on Permit Application #5 (obtained from Building and Zoning
Office). I/we understand that any ersons 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, a Stop Work Order and a court summons.
Sign in the presence of No ry PubILc—
wrier
Owner
T foregoing Affidavit was acknowledged before me on this < O day of
c7---? _(month, year)by b erz t H tf-� , ram'C
Witness my hand and official seal
My commission expires:
My Convdssion E)#res o'tary Pu
06/28/2006 ( Cl
say North C_oliege Avenue • P.O. Box 580 o Fort Collins, CO 80522-0580 - (970) 221-6760 • FAX (970) 224-6134