HomeMy WebLinkAbout912 PIONEER AVE - AFFIDAVITS - 3/13/2009Community Planning and Environmental Services
Building and Zoning Department
HOMEOWNER/BUILDER AFFIDAVIT
City of Fort Collins
I/we6�v C_ lY� �!;* T as owner(s) of record of the property located
(01fiase print)
at % 2 W,1I e e r 1X'1 �' D�i�1,_� Fort Collins, Colorado, hereby declare and attest to
(please print)
the following (please check A, 6orC, whicheve-aqo%es)
❑ A I am/ we are acting on my/our benalf 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
zi 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 perf iL in�c all f the rk r veil be continuously supervising unpaid volunteers
The work is directly related t e�c�o �r �zon f e a o e referenced home, which is described more
fully on Permit Application (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 witn 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 cf any fees that have been
collected, a Stop Work Order and a court summons
sign in the presence of Notary Public
Owner Owner
Tne
g Afridavit was acknowledged before me this c3L day of
�h d�jS Cgjgth, year)by "uo
'OFnY �-
Pr�
Witness my hand and off ici o¢ l "01
BEN .
My commission expires 7ruR D
1Y COMMIS2 OI EypIRES 2011
juy
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Notary Public
261 NurLn College 'venue PO Box D80 Fort Collins CO 80522 0580 • (970) 221 6760 FAY (9-0) 224 6134