HomeMy WebLinkAbout1100 E Oak St - Affidavits/Homeowner - 12/28/2016.., I.i r ...:,.�,y C •r"iCBS
PO Box 580
281 N College Ave
Fort Collins, CO 80524
970-416-2740.phone 970-224-6134 fax
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I/we, \j I� -e^^ ljoe as owner(s) of record of the property located
At: l 100 W. Dad QJ V, F 6 . i , 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 horne to be constructed is on the above property and
will be my/our primarV residence. I/we have not personally constructed any other new homes
in the Fort Collins city limits within the past 21-month, period.
OPTRON 2:
I amhwe 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 property and is my/our personal ,)rirnar
jf
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 prinnary 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 1--te
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
(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 mazy result in revocation of any permils
associated wish 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 lary Public
Owner Co-owner
The foregoing Affidavit was acknowledged before me on this day of
Witness my har
My commission
'1012014