HomeMy WebLinkAbout604 SMITH ST - AFFIDAVITS - 7/30/2010ti
�C of Planning Development and Transportation
Collins 28 Box
�JI t 281 N College Ave
Ft Collins CC 80524
I C 970 Z21 6760 phone 970 224 6134 fax
Vwe" V l G IG, �T , J'r� � as owner(s) of record or the property located
At cr7G YYl "1 Y7 �� 7 Fort Collins Colorado hereby declare and attest
to- the following (please check only the one that applies)
❑ 1 am/ we are acting on my/ our behalf for the purpose of obtaining a budding permit and personally
constructing my/our home The nome to be constructed is on the above property and will be my/our
primary residence Vwe have not personally constructed nay other new homes in the Fort Collins
crty Ilmds 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 amAive are acting on my/our behalf for Vie purpose of obtaining a budding 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 Vwe 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 personally performing all of the work or will be continuously supervising unpaid volunteers
The work is directly related io the construction of the above referenced home which is described more fully
on Permit Application # CY) 1 0Z (obtained from Building and Zoning office) Vwe
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
Vwe 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 p serce of ota Putrric
i
er Cc owner
The foregoing Affidavit was acknowledged before me on this 3l 4k day of
�•1( Q\� 0 /n (month year) by �) CK S14 tw.
�,O iU
Witress my hand and ofnctal seal a
NOT. Cis
My commission expires goo r6<9y
sya 1C Ge�a
F / -e,l 9A- O !//,l/1
a CC>LORP� "�
Notary Public