HomeMy WebLinkAbout605 W LAKE ST - AFFIDAVITS - 6/27/2003t �r r_' I -1 ,
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HO M EOW NER/ BUILDER L FFID_t, VIT
l�:rh�- ua 1'Urt f�'u1k�:rrs
)PA195 ASS tt�`--� aS OV,/Il 'I"(`,) Of 1-C-Er,rd of the property locate-'d
plea' e print
at: �$ul•I-AF1 �r Fort Collins Colorado, here -by declare and attest to
the follovrinchzcL A; E nr Cl wNcheiler app11E,:7
A. I Elm/ we are acting on my/our behalf for the purpose of obtaining a building permit and
personally constructing my/our hon-le. The home to be corstructed is on the- above prop -ley and
Will be n-ly/our prin-iary residence. I/we have not personally constructed any other new hon-je in Fort
Collins city limits within tl-ie past 24-month period.
B. I an"i/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 hon-ie 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 Eware that I/we cannot do any
structural, electrical, plumbing or mechanical work. !/V%le 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 supen/ising unpaid volunteers,
The work is directly related to on r a v eferenced home, which is described more
fully on Permit Application l (obtained from Building and Zoning
Office), I/we understand that any persons 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 oI any fees that have been
collected, a Stop Work, Order and a court summons.
Sign
Owner
Thf foregoing affidavit was acknowledged before m on this D� day of
C� C� 3 (month year)bys a.rn Q,�j _ ��� beA 4
VVitness my hand and official seal
My commission expires:
My Commission Expire,
ODP W006
(Io �V lyary Public
ittI _r,11�2e =_i C,,L,� PO. Bnx 0 Fort Collin CC) SC r� _ G % � ,
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