HomeMy WebLinkAbout613 FLAGLER RD - AFFIDAVITS - 6/24/2003dy�y L_i-}:ITITII C1Tt.:i'�\' 113 i1I1.1T} ;l (:Cl` 1.1'irl'lT7 rC1'l f.a� 'rtl" 1 _5
BC111 (i]i`, arld=.C1ILL]LC LJ ]_, l2' �r}c:nt
HOMIEOW NER/BUILDER I.FFIDAVIT
C'JIv u_l f-ol-I C.i7111.1is
of recorcl of the property located
�3 r �iLa�e 1),;1
at: F� Fort Collins, Colorado, Hereby declare and attest to
(please print
the following: (ple4se fhei-J: A, S or C, !� hichever applies]
o A. I an-1/ we are acting on imy/our behalf for the purl_,ose of obtaining a building permit and
personally constructing my/our hon-1e. The Home to be constructed is 01-1 tl-1e above properly and
Will be n-Jy/our primary residence. I/vote have not personally constructed any other new hone 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 pern-lit 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. I4%,e must Eire 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 supers/ising unpaid volunteers.
The work is directly related to the co r tion of he b e referenced home, which is described more
fully on Permit Application _ (obtained from Building and Zoning
CAOV
Office). I/we understand tha n erson o g—Ytc ontracteo 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.
1/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 . esence of a Notary Public
dA'A 01 , . I T� Al 11,
Owner
Owner
The foregoing Affidavit was ad<nowl edged before me on this day of/
0200 (month, year)by Ja 5u-PN jamA-AA /vi F}O+ WL ,4
Witness my hand and official seal
Icy commission Expires:
My Comm z on Tres
N ary Public n /
_C:I J`:,_�lj'� l_,-,]JNrsr i,>t i'7-iL1[ P0, Bax JOiI Fo�"i Collins._Co C�oS—= o��oO �G:'��) �_].-L,l!�i) ='_ (�i^IJ) ---1-,1.=-�