HomeMy WebLinkAbout3019 Rockborough Ct - Affidavits/Homeowner - 07/06/2016City of Building Services
PO Box 580
6
�; �' 281 l�l College Ave
�� Fort Collins, CO 80524
970-416-2740.phone 97
0-224-6134fax
HOMEOWNER AFFDAVF
I/we, s �I�l �Vcty , as owner(s) of record of the property located
At: �0^T_It? M-25 , Fort Collins, Colorado, hereby declare and attest.
to the following: (please check only the one that applies):
OPTION 1:
OPTION 2:
OPTION 3:
❑ 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.
Jul 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 primarlf
residence.
❑ 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 it
151 CPC -9 �3-8& (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 presen a of ota Public
Owner
6-owner
The foregoing Affidavit was acknowledged before me on this �� day of
20 lU (month, year) by oYI 0�' Gl a �i��J
Witness my hand and official seal CKvjso Ph_v- Nallov
My commission expires: G3_ 11.2�2_0 {'L%
N ,ta P blic
TARYN HENN10
NOTARY PUBLIC
STATE OF COLORAD11404
NOTARY ID 02016460109
MY COMMISSION EXPIRES 03-1
611012014