HomeMy WebLinkAbout2113 Kirkwood Ct - Affidavits/Homeowner - 05/08/2017pity of
t Collins
8utlding Services
PO Box 580
281 N College Ave
Fort Collins, CO 50524
970-•416-2740 phone 970-224-6134 fax
HOMEOWNER AFFIDAVIT
Owe, e , as owner(s) of record of the property located
At 3'kj.ff LWQi% s� ( , 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 budding 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 primar
residence
AJ4t111113 ];
❑ 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 primarV 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 11
(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 summgri y
Sign in the presence of Notary Public
OWnOr / // r V I ,Q Co-owner
The foregoing Affi(d�avit was acknowledge of/ore me on this
y 7� day of
`�� (month, year) by
Witness my hand and official seal
My commission expires
NotaryPublic
�y o DENISE M WARREN vrsed6/i0/2014
Notary Public
State of Colorado
LFJC
2564 Notary ID #19934012893
My Commission Expires 03-01-2021