Laserfiche WebLink
L16: City <br />f <br />Louisville <br />COLORADO • SINCE 1878 <br />Submit this form to the Chief Building Official in the Department of Planning and Safety, Louisville City hall, <br />749 Main Street, Louisville, Colorado, 8002,7. <br />AFFIDAVIT <br />This affidavit certifies that I,1ohn P Ruppert, hereby allege that <br />(Name) <br />Severy Creek Roofing, Steve Louden, Lic# LSVL-001704-2018 committed one or more acts prohibited by the <br />City's building code and request that the City make a motion to the Building Code Board of Appeals (Board) to <br />schedule a hearing to consider an administrative remedy of temporary suspension or permanent revocation of <br />the license or registration. In signing below, I acknowledge that the City may not make the motion to the <br />Board if my complaint cannot be verified by the City Building Official. <br />hearby swear or affirm that the facts and statements set forth below are true and correct to the best of my <br />knowledge and belief. n <br />Signature of Complainant: <br />Physical Address of Complainant: 641 Saint Andrews Lane Louisville, Co 80027 <br />Mailing Address: Same <br />Business Address Phone: 303-818-8288 Residence Phone: 303-818-8288 <br />Fax: NA <br />STATE OF COLORADO <br />COUNTY OF BOULDER <br />Email Address: jruppert19S7@yahoo.com <br />Before me, � J.}!� 1,f1t, a notary pub "c, authorized to administer oaths, in and <br />for said State of Colorado, personally appearedwhose name is <br />subscribed to the foregoing Complaint Affidavit, and who affirms, said statements are true and he/she <br />acknowledges for execution of said instrument to be of their own free act and voluntary deed for the uses and <br />purposes therein set forth. <br />Subscribed and affirmed before me this ,day of <br />(Sea!) Chrtna Lry,Sta <br />Nota <br />b� <br />Sbate <br />flf <br />ry ID 2013 <br />Kh °7""'"4+on rtb 4, zoos <br />Commission Expires <br />Page 2. <br />