HomeMy WebLinkAbout1681 Sprocket Dr - Affidavits/Homeowner - 10/26/2015nfr Building Services
PO Box
��v'l1 �����U UY /� 1 .' 281 N Colllle;e Ave
/� Fort Collins, CO 80524
970-416-2740 phone 970-224-6134 fax
I/we. �( a /-,V �/�� e\O_ ^,' _ as owner(s) of record of the property located
At: Sr( S�r� c(C�r- br1 Fort Collins, Colorado, hereby declare and attest
to the following: (please check only the one that applies):
OPTION 1:
OPTION 3:
❑ 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 jDrimarli residence. I/we have not personally constructed any other new homes
in the Fort Collins city limits within the past 24-month period.
rV I am/we are acting on my/our behalf for the purpose of obtaining a building permit and
(71 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 primary
residence.
❑ 1 arn1we 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 mare 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/kve 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 Ares ce o 'Jot- Public
s
Ovmer
The
The foregoing Affidavit was acknowledged before me on :his
Co-owner
day of
(month, year) by P-LCVWJA Ci FiTUIS
Witness nmv hand and official seal V_,�IjED
My commission expires:
Notary Public
KIANA SADE CARTER
NOTARY
PUBLId
STATE OFCOLORADO Revised 611012014 LORA
NOTARY ID # 20144039424
MY COMMISSION EXPIRES OCTOBER 09. 2018