HomeMy WebLinkAbout121 S WHITCOMB ST - AFFIDAVITS - 4/22/2004Community Planning and Environmental Servicesojj���
Building and Zoning Department
HOMEOWNER/BUILDER AFFIDAVIT
City of Fort Collins
I/we, A v - ��t T - as owner(s) of record of the property located
(ple s print)
at: gals W Jtc�olyv �' , 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 and 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 construction of th a v referenced home, which is described more
fully on Permit Application # in% (obtained from Building and Zoning
Office). I/we understand that a y CD s or agents contr cted 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 presen tary
"_"
IDwner Owner
The foroggoing Affidavit was Faye' efore me on is daX o
't••'j'mont e by L gQiC� (041nO Sri
Witness my hand and o c of seaEDNA
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My commission expires: Ca.rn
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Notary Public
HIV Commission Expires DoC. 2,2= ry
281 North College Avenue • P.O. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6760 • FAX (970) 224-6134