HomeMy WebLinkAbout2439 Maple Hill Dr - Affidavits/Homeowner - 01/18/2017PO Box 580
281 N College Ave
Fort Collins, CO 80524
970-416-2740_phone 970-224-6134 fax
I/we, oArl
as owner(s) of record of the property located
At: z2= Fort Collins, Colorado, hereby declare and attest
to the following: (please check only the one that applies):
OPTION P:
❑ I 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 primarV 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 oblaining 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 jirimary
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 primar t residem e. 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.
am/vve re 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 I/
(obtained from the Building Services office).
l/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 permils
associated with the above Permit Application number, forfeiture of any fees that have been collecicd, a Slop
Work Order and potentially a court summons.
Sign in the presence of Notary Public
(A1,;4
—�
Owner
Co-owner
The foregoing Affidavit was acknowledged before lm,�e ton this day
I day, of,� A '
C + - a O (month, year) by 0A �i I ST I ru—) m� f. �E l (� Ili
Kfiy c hand and official seal
Ivy commission
sion expires:
Notary Public
KIA NOTARDY P BIE A TER
STATE OFCOLORADO
NOTARY ID # 20144038424
MY COMMISSION EXPIRES OCTOBER 09. 2018
Revised 611012014