HomeMy WebLinkAbout631 MEADOW RUN DR - AFFIDAVITS - 5/27/2010Eon
Planning Development and Transportation
on28 Box ogle
l CollinsJ Ft N College Ave
Ft Collins CO 80524
970 221 6760 phone 970 224 6134 fax
as owner(s) of record of the property located
At: �3L /1�dow �. �� i J1f_ Fort Collins Colorado hereby declare and attest
to the following (please check only the one that applies)
❑ 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 nay other new homes in the Fort Collins
cclimits within the past 24-month period
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 house The house to be altered is on the above
property and is my/our personal residence
❑ 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 house
to be altered is my/our personal residence I am aware that Uwe cannot do any structural
electrical plumbing ore mechanical work and must hire contractors/subcontractors who are
currently licensed and insures with the City of Fort Collins
I am/we are personallyrfprgri�rk be continuously supervising unpaid volunteers
The work is directly re l tdd1111 0 of ove referenced home which is described more fully
on Permit Application (obtained from Building and Zoning office) Uwe
understand that any person(s) or agent(s) 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
Uwe 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 pre rice Notary P is
OA
Owner
Co owner
The foregoing Affidavit was acknowledged before me on this ��% 4 n day of I
(month year) by L
Witness my hand and official seal DOOV
My commission expires
l/1�0Notary Public