HomeMy WebLinkAbout3201 Fairplay Ct - Affidavits/Homeowner - 09/02/2015CRY
®f Building Services
580
F Lr Co���II fJ 2816ox N Cotllege Ave
MID
���Fort Collins, CO 80524
as '.rr 970 416 2740 phone 970 224 6134 fax
HOMEOWIM R ELF s V DAM
6 `CirL�T�� �I-l�cam. I/we, , as owner(s) of record of the property located
At: JLi(�QVj�1j C I 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 primmy 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 •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 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 thepresence of Notary Public
0 er
Co-owner
The foregoing
Affidavit was acknowledged before me on this day of
ZOI %onth. year) by 9_1I rs r_V1
Witness my hand and official seal
My commissi
MARGARETR.CLANCY
NOTARY PUBLIC
STATE OF COLORADO
MY COMMISS ONIEXPIRES AUGUST 00, 2017
Notary
Revised 611012014