HomeMy WebLinkAbout1530 Freedom Ln - Affidavits/Homeowner - 05/13/2014City Of
. p. t3rri[din_ `' rvices' '
PO Box 5:,:)
281 N CollL'ae Ave,
Ft Collins, CO 80524
0 970-416-2740 phone 970-224-6134 fax '
raa. Ei : ,.B AY
�,p
�i
p ''.11 'II J•C 1
lMie, ..2=�rtaolj W�dAas owner(s) of record of the property located
At: EU14J 44 .LDS - Fort Collins„Colorado, hereby declare and* _attest'•,:
to the. following: (please check only the one that applies)
OPTION 1: 7.
❑ 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. l/we have not personally constructed any other new homes,,
in the Fort Collins city limits within the past 24-month period.
OPTION 2:
I am/we are acting on my/our behalf for the purpose .of. obtaining.a building permit and
personally constructing an'alteratiori or addition to my/o'ur house, acting as our own general
Y contractor. The' house to be, altered, is,on the above. proppgy,pnd is my/our 61rimary
rima
residence. -
OPTION 3 r.
J
.0 I rn/we are acting•on.my/ou,r behalf for the purpose.of obtaining�a,building permit and.
personally constructing anon -structural, alteration to my/our attached single family dwelling,,
unit. The house to be altered is my/our personal' nma 'residence. I am aware that l/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 personallype.rforrrming all of the work or hiring City of Fort Collins licensed trades`peop)e'; or'will' be*!'
continuously supervising unpaid volunteers (see Option 3 for attached dwellings). The. work is directlyrelated
to;the construction of the abovei referenced home', which, is described riore fully on Permit Application #
'(obtained from the Buildmng Seriilces ofFlce);
I/we understand'that'any person(s) or agent(s).contracted to perform structural wood -framing, plumbing;
HVAC, electrical or roofing work MUST BE licensedcontractors 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:reyocation ofany permits
associated with the above Permit Application, •forfeiture,of any1ees that have been collected:'a. Stop
Work Order and potentially a court summons:
Sign in the presence of Notary ublic
.. Owner.,; �A ,' •, co-owner,);, .
The foregoing Affidavit was acknowledged_ before me on this day of
(Mon "ear) by �-:'n
KAREN
Witness my Band,and offrcral seal: THARP
My commission expires" `P�
9
�oFCo� Notary PublicIV
r,
MY COMMISSION' EXPIRES ai
6.
July 21,2015 .