HomeMy WebLinkAbout7319 Silver Moon Ln - Affidavits/Homeowner - 04/21/2014City of
Fort Co a
14U
.
Building services
PO Box 580
(1Z%i1 N Coll ge Ave
Cons, CO 80524
0-4'1'6-2740 phone 970.224-6134 fax
'HOMEOWNER k"FIDA ITS
I/we; ; as owner(s) of record of the property located
At %Fort 'Collins, Colorado, hereby declare and attest
to the following: (please check only the one that applies)
OPTION 1:
❑ 1 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 prima residence. I/we have not personally constructed any other new homes
in the Fort Collins city limits within the past 24-month period.
OPTION
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, acting as our own general
contractor. The house to be altered is on the above property and is my/our personal prima
residence.
OPTION 3:
❑ 1 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 Prima 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 and insured with the City of Fort Collins.
I am/we are personally performing all of the work or hiring City of Fort Collins licensed trades people, or will be
continuously supervising unpaid volunteers (see Option 3 for attached dwellings). The work is directly related
'to the construction of the above referenced home, which is'described more fully on Permit Application #
(obtained from the Building Services office).
` I/we understand that any person(s) or agent(s) contracted to perform structural wood -framing, plumbing,
HVAC, electrical or roofing 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 potentially a court summons.
'Sign in the presence Notary Public
I
Owner Co-owner
S4-
'The foregoing Affidavit was acknowledged before me on this day of
n :Pui�1i
LI DSAY MITTERHOLZER
Witness my iand and.offici
My commiss on expires: aftRYPIUBLIC
STATE OF COLORADO tary Pub c
NOTARY ID 20144000998
MY COMMISSION EXPIRES JANUARY 08, 2018