HomeMy WebLinkAbout624 YARROW CIR - AFFIDAVITS - 10/16/2003City of Fort Collins
JIM NELSON C0NsTRUG
and Enviroainental Services
Building and Zoning Department
NOMEOWNtER/BUILDER AFFIDAVIT
PAGE 02
owner(s) of record of the PPOPery located
tPIase opt) Collins, Colorado, hereby declare and attest to
the following: (please 04ta* A, B or C, lvhic/rever app/lest
a 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
will be my/owr primary residence. uwe have not property and
Collins city limes; within the past 24• personally consbvcted any other new home In Fort
pa month period.
XB. I am/we are acting on my/our behalf for the purpose of obtatnin a buildin Personally constructing an alteration or addition to my/our home. The home to berms ISe
nd
above property and is mylour personal residence. on
0 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 mitered Is our personal residence. I am aware that I/we cannot do any
structural, electrical, plumbing or mechanical work. I/we must hire cOntradvrs/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
The work is directly related to the construction of the above referenced homewhich is des abed mores
fully on PemVt Appikation #
Office). * I/we understand that any persons or (obtained from Building and Zoning
we u agents contracted to perform structural wood•f ming,
plumbing, , elecbical 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 perrnits 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 p a /Votary Public
Owner
Owner
The f ving Affidavit was acknowi b me on this 6
" CTy r'3r-'�'c,3 {month, )by
Cs�riaac� day of
�• r��r, tsb+i
Witness my hand and official seal
My com _ I I -- --
tClsaw
NOTARY PUBUC
STATE OF ARQONA
GEORGE�. W.IN
No ry PubiCamrtaarogmp
?A7 North Collerte Avenue • PQ. Box 580 • Fort Collins, CO 80522-0SBp •
(970} 221 6760 FAX (970)224-6i34
14/16/2003 THU 08:48 [TX/RX NO 5840] IZO02