HomeMy WebLinkAbout5430 Fossil Ct N - Affidavits/Homeowner - 12/03/2015CKYof �
F,or t C�oWns
Building Services
PO Box 580
28.1 N College Ave
Fort Collins, CO 80524
970-416-2740 phone 970-224-6134 fax
I/we, ;C tii , -)-, %'Cv yvas owner(s) of record of the propertLy located
At: �; IC�r C �i: Fort Collins, Colorado, hereby declare and attest
to the following: (please check only the one that applies):
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OPTION 1:
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❑ I ant/ 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 Primary residence. Uwe have not personally constructed any other new homes
in the Fort Collins city limits within the past 24-month period.
OPTION 2:
❑ I 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 primary
residence.
OPTION 3:
l 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 primaiij 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 arm/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 ier uGlic
OwneLQJ Oo-ov✓ner
T he fcreaoing Affidavit was acknowledged before me on this 3Ap day of
.� 02ol0 (month; vear) by 4UDr4LG �Psy
Witness my hand and oi seai
My commission expires:
MARCUS GLASGOW
y� NOTARY PUBLIC
,^Fa STA'iF Or COLORADO
NOTARY ID # 20124050586
MY COMMISSION EXPIRES AUGUST 22, 2016
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Notary Public
Revisec 6%10/2074