HomeMy WebLinkAbout404 Briarwood Rd - Affidavits/Homeowner - 01/15/2015pity of
1/10�t Co�Q�f�ls
Building Services
PO Box 580
281 N College Ave
Fort Collins, CO 80524
970-416-2740 phone 970-224-6134fax
HOMEOWNER AFFIDAViT
I/we, LZ2 as owner(s) of record of the property located
At: YI i�Fid Fort Collins, Colorado, hereby declare 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 rip 'mare residence. I/we have not personally constructed any other new homes
in the Fort Collins city limits within the past 24-month period.
OPTION 2:
2-- 'lam/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 rip mare
residence.
OPTION 3:
❑ 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 rip •mart/ 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
offto ti co 'strutl n o th . ab(, rZZqqnced home, which is described more fully on Permit Application #
�� (o to em the Building Services office).
UL me
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 presp5ce of Notary Public
t0wiler
'I
The foregoing Affidavit was acknowledged before me on this. �
p�
( (month, year) by
Witness my hand and official
My commission expires: MARGARET R. CLANCY
NOTARY PUBLIC
STATEOFCOLORADO
NOTARY ID # 20134040425
MY COMMISSION EXPIRES AUGUST 06. 20W
Co-owner
day of
Notary P
Revised 611012014