HomeMy WebLinkAbout1321 Buttonwood Dr - Affidavits/Homeowner - 07/09/2015Cu try/ of
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I/we,
Building Services
PO Box 580
281 N College Ave
Fort Collins, CO 80524
970-416-2740 phone 970-224-6134fax
HOMEOWNER AFFDAVff
as owner(s) of record of the property located
At: (321 1J `Ljf `''-C)' aY- 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 rid marl 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:
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 rip -mart/
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 primarV 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 of Notary Public
Owner
Co-owner
The foregoing Affidavit was acknowledged before me on this day of
�j �`� ! (month, year) by jQ,i'"2 w&S+fc ou enS
Witness my
is hand and official seal t /, �
My commission expires: RR t��
KIA NOTARY CASTER Notary Public
STATE OF COLpUBLIG
(
I NOTARY ID N 20144039424 Revised 6/10/2014
;•,oMMtssj0N EXPIRES OCTOBER 09, 2016