HomeMy WebLinkAbout217 2nd St - Affidavits/Homeowner - 01/31/2017JiL V j� II
�- &t C®���ns PO Box 580
281 N Colle6e Ave
Fort Collins, CO 80524
970-416-2740-phone 470-224-6134fax
(�,�� HOMEOWNER AFFIDAVIT'
I/we, e 7"t �� ��5� -- as owner(s) of record of the property located
At: a't r-) " , Fort Collins, Colorado, hereby declare and attest
to the following: (please check only the one that applies):
OPTION 1:
Ov 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 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 rima
residence.
OPTION 3:
❑ 1 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.
B1Im/7e Qr Qr4a6pGorming 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 I/
btained from the Building Services office).
fo 1/w understand th an 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 Slop
Work Order and potentially a court summons.
Sign in the presence of -Notary Public
' — ._-----....- .....
Owner Co-owner
foregoing Affidavit was acknowledged before me on this day of
,The
� 11�kLJ' ao I (month, year) by ns,� ct�
Witness myhand and official seal
My commission expires:
KIANA SADE CARTER Notary Public
NOTARY PUBLId
STATE OF COLORADO
NOTARY ID 0 20144039424 Revised 611012014
MY COMMISSION EXPIRES OCTOBER 09 2018