HomeMy WebLinkAbout2845 W Elizabeth St - Affidavits/Homeowner - 06/28/2016crty0f
F6rt Collins
Building Services
PO Box 580
281 N College Ave
Fort Collins, CO 80524
970-416-2740 phone 970-224-6134fax
\I l HOMEOWNER AFFIDAVIT
I/we,��� VC�v� IBC as owner(s) of record of the property located
At: ���" W. �l `.ul Fort Collins, Colorado, hereby declare and attest
to the following:'(please check only the one that applies):
OPTION 1:
❑ 1 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 Primary 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:
❑ 1 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:
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 Primary 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 #
gbbtaine.d'tom;the Building Services office).
JV
I/we=understand,,tt et`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
r (ice+
Owner
Co-owner
The fore oing Affidavit was acknowledged before me on this 4-29
day of
V OUGtt (month, year) by aA ( ' e,
Witness my hand and officia seal LISA V OLSON
My commission expires: STATE
OF COLORADO
NOTARY ID 20124064930.
My Commission Expires October 19,. 2016
Revised 611012014