HomeMy WebLinkAbout810 E MYRTLE ST - AFFIDAVITS - 9/10/20093�
Community Planning; and. Environmental Services
Building and Zoning Department \/\ HOMEOWNER/BUILDER A IDAVIT
City; of Fort Collins G2oo
ty
I/we, as ownerOs . property of record of the located
(please print) r,
at: 8/0 Z'4 ,f�7t 5' , Fort Collins, Colorado, hereby declare and attest to
(please print)
the following: (please check A, B orC, rirhicheveraoplies)
o 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 the construction of the above 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 structuralwood?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 presence of a Notary Public
Owne
Owner
The oregoing Affidavit was acknowledged before me on this hl da f
(month, year)by``
P
Witness my hind a (,hP.# seal e�
My commission expires:
A
=N��G
OF covo Notary Public
281 North College Avenue • P.O. Boy 580 a Fort Cogins, CO 80522-0580 a (970) 221-6760 4 FAX
) 224-6134