HomeMy WebLinkAbout7015 Autumn Ridge Dr - Affidavits/Homeowner - 05/02/2017B 17 0 2 3 2 .a i r'1CC-S
Fort C
oro �j n 28 Box 580
_ l4lt 2 1 IJ College Ave
Fort Collin-, CO 80524
970 416 2740 phone 970-224 6134 fax
I/we, ,3g Y,--:�:_A h 50
ii�z!6_n.`d11Nc-R A r ILFAV" i
as owner(s) of record of the property located
At 70I IT AA i m k i�, �c P v Fort Collins, Colorado, hereby declare and attest
to the following (please check only the one that applies)
OPTION 1
❑ I am/ we are acting on my/ our behalf foi the purpose of obtaining a building permit and
personally constructing my/our home The home to be consti ucted 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 peiiod
OPTION 2
pf I am/we are acting on my/our behalf for the purpose of obtaining a building permit and
personally constructing an alteration of addition to my/our house, acting as our own geneial
contractor The house to be altered is on the above property and is my/our personal primary
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/oui attached single family dwelling
unit The house to be altered is my/our personal piimai V iesidence I airs aware that I/we
cannot do any structural, electrical, plumbing of mechanical work and must hire
contractors/subconti actoi s who ate currently licensed and insuied with the City of Foil Collins
I am/we are personally performing all of the woik or hit ing City of Font Collins licensed trades people, of will be
continuously supervising unpaid volunteers (see Option 3 foi attached dwellings) The work is diiectly related
to the construction of the above referenced home, which is described moie fully on Permit Application it
(obtained fi om the Building Services office)
I/we understand that any person(s) or agent(s) contracted to perfoi m 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 failuie to comply with any of the above conditions may result in revocation of any pei mils
associated with the above Permit Application number, forfeiture of any fees that have been collected, a Slop
Work Older and potentially a court summons
Sign in the presence of Notary Pubhc
Owner
Co-owner
The foregoing Affidavit was acknowledged before me on this 2 day of
mq (month, year) by t7 04
Witness my hand and official seal
My commission expires
Nota
CORINA HARTZOG
Notary Public
State of Colorado Revised 6/10/2014
Notary to # 20174008848
My Commission Expires 02 27-2021