HomeMy WebLinkAbout221 E Swallow Rd - Affidavits/Homeowner - 08/13/2014City of T:)
(Aildih.-: r--rvices
PO Box 5::)
281 N Cot(, - ge Ave
Ft Collins, CO 80524
-970-416-2740 pho-ne 970-224-6134 fak
HOMEOWNEF X',,T1DA1%tfh
I/We, L`t t-1VA-lz as owner(s) of record of the property located
At: ca SuiUOW: RJ Fort, Collins, -Coloeado,,hereby declare:arfd.attei.... i :
.to the.following: (please check only the one that applies)
13 1 am/ we• are acting on my/ our behalf for the purpose of obiain'inga* buildi n*g permit and
persofially constructing mylour home. Thehome to be,
constructed. is on the above property, and
will be my1our'prima residence. I/we have not personally Constructed any other new homes
in the Fort Collins city llmft§'.Within� the p"ast: 24-month-pe'ri6d.
OPTION 2:.
I am/We are acting on myloUr behalf for the purposeof. obtaining,. a building permit and
personallyconstructing . ctind an . alterati'6n'or'a�idition:to'myfo'Ur house, 'acting. as our . i o : wn - ge - neral
contractor. The house to be, altered;ison the above 'property, and is my/W 'personal orkna
OPTION 3:
0 1 6m/we are acting, on mylour.behalf for. the purpose.of obtaining - . a building permit and
. � 1 1: .. . -lly constructing personally a non structural, I attached single alteration to my/p. 9gle-faffilil alteration . .. i - .. . -., .... Y dwelling
unit. The housd to be aiiterbd.1s'riiy/ourpersona1 prima residence'. I a'm aware'�that I1W6-
cannot do any structural, electrical, plurn6ihg or, mechanical work and must hire
who.' '' 11 - � Y6 d'. d insured . t I
contractors/subcontractors are currently,!9ppse.. an with the -City F rt, I ty of 0 Co fin
I am/we are personally performing all of the workor hiring City of Fort Collins li'Ge'nsed: trades people; 6r'will:be.
': -
continuously supervising unpaid volunteers (see Option 3 for attached dw6llings)-. The. work Js dir'ectfy related
tdthe- construction of the above: referen6ed home;, Whi6h: is:&S*6r11'eb .j ,m
ore fully on Permit Application #
(6btaine'd,ff6m''th-6 13-uildihb S6rvic'e§ office)
I/ e understand that 'any person(s) or agqnt(s). contracted to perform structural wood -framing, plumbing;
HVAC*, electrical or roofing work MUST BE licensed a sructul'i �:d-fedmihg,
cont,�. ct,pts in accordance With the regulation of the City of
Fort Collins.
understand that failure to•.co'mplywltWany of ft-6bove,.-conditions may result inlreybcation of any permits...
associated with the above Perrhit Application-n6imilber; f6rfeitur'eiofany44ets tha ha t ve been collected, ;:a.StO6'p
Wo,rk Order and potentially a court summons:
Slj'.n In the presence of Notary Public':
Owner -
Co - owner
,,,
Th6'foregoing Affidavit was acknowledged before'rne on this day of
AL&,rut-ct (mo ear) b'
Y-- W SC
PO
Mhess'my hand and official
My,,'�ornmissibn ex KAREN
TH . ARP
Notar
y.
OFC
MY COMMISSION EXPIRE5
july 23, 20`15