HomeMy WebLinkAbout609 Park St - Affidavits/Homeowner - 12/14/2016PO Box 580
281 N College Ave
Fort Collins, CO 80524
970-416.2740.phone 970-224-6134fax
I/we, �� I i L GcD ` , as owner(s) of record of the located
C�j c property
At: � 0 1 � �L J� , 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 priniai-V 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:
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 oven general
contractor. The house to be altered is on the above properly and is my/our personal 13rimarV
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 alteralion 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 Fart 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 Coffins.
I/we understand that failure to comply with any of the above conditions may result in revocation of any permils
associated wilh 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 pre ence of Notary Public
Owner
The foregoing Affidavit was acknowledged before me on this
a
Witness my hand and,i
My commission expire;
Co-owner
day of
2014