HomeMy WebLinkAbout3024 Stanford St - Affidavits/Homeowner - 05/10/2018City Of Building Services
580
Fort Collins 281Box N College Ave
Fort Collins, CO 80524
970 416 2740 phone 970 224 6134 fax
HOMEOWNER AFFIDAVIT
I/weyfll� �� )>� I CQ as owner(s) of record of the property located
At J2�21-/ � r�To rc� R—'CA 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 prima re 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 own general
contractor The house to be altered is on the above property and is my/our personal rp mau
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 prima ry 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 abov referenced home which is described more fully on Permit Application #
f btped from the Building Services office)
U M
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 p ence N tary Pu c
caner
Co owner
The foregoing Affidavit was acknowledged before me on this l r)*41 day of
o v (month year) by Rum w l b tuy\ w w o—ul '
Witness my hand and official seal
My commission expires
Notary Public
KIANA SADE CARTER Revised 611012014
NOTARY PUBLId
STATE OFCOLORADO
NOTARY ID N 20144039424
MY COMMISSION EXPIRES OCTOBER 09 2018