HomeMy WebLinkAbout1725 Barnwood Dr - Affidavits/Homeowner - 01/13/2017City Of Building Services
580
F®r t C®lfor s 281 PO Box N College Ave
Fort Collins, CO 80524
970-A16.27-10.phone 970-224-6134 fax
HOMEOWNER AFFIDAVIT
I/we, A !Q n EII w" —,as owner(s) of record of the property located
At: 6 dd 1In I Z1 Yl 6 C7- 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 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:
T\ 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 own general
contractor. The house to be altered is on the above property and is my/our personal primar
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 rip mars 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 Pe above referenced home, which is described more fully on Permit Application #
btained 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 summons.
Sign in the presence of Notary Public
Own
The foregoing Affidavit was acknowledged before me on this
Co-owner
day of
A 11 (month, year) by
Witness my and and official seal
My com
_
Notary PublicmO0Revised 611012014
3-M