HomeMy WebLinkAbout1841 Busch Ct - Affidavits/Homeowner - 06/02/2014City of. BuilcIM, `^ •rvices
'q �� Ip� �T PO Box 5;.:)
0Ek"''= is It d 281 NCott, •geAve
Ft Collins, CO 80524
�n �� 97U-416-[phone hone 970-224.6734 fax
00A4
/we, [AA22,as owner(s) of. record of the property located
At; t �`L) l�r r;�� Ca _ Fort Collins, Colorado, hereby deolare.and attest .:
to the.following: (please check only the one that applies)
_OPTION 1: ,
❑ 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 Prima residence. I/weyhave not personally constructed any other new homes
in the Fort Collins city Iimits,wifhin the past 24-month period.
OPTION 2:
i I am/we are acting on my/our behalf for the purpose of obtaining a building permit and
\personally constructing an'alteration o,r addition to my/our house, acting as our own'general
contractor. The house to be altered, !son the above property and is my/our personal prima
residence., -
OPTION 3:
0 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 rima residence. I am aware that I/we
cannot do any structural, electrical, plumbing or mechanical work and must hire
contractors/subcontractors whq,6re 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
t the constructionci'th raNA rleferenceid home, which, is'described more fully on Permit Application #
obta�nedrorn the Building Services office).
L , Get
Wre 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.
1/*e 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 of Notary Public
err
Co-owner
The foregoing Affidavit was acknowledged' before
� me on this i� CIL day of
�IAiI L c 04 (month, year) by V�Oit i�c- LY/iiis✓o. CSC
Withess my hand and office
My commission expires: z 'oc �✓ •'
Notary Public _r
My COMMISSION EXPIRES:
July 23, 2015