HomeMy WebLinkAbout901 EDWARDS ST - AFFIDAVITS - 10/19/2015I �.L$�! C?lu� Building Services
li=68) r� )1 �ans- 28 Bor. 580
+.-u �L ll ?_81 N College Ave
�.w�- ---�, Fort Collins. CO 80524
970-416-2740 phone 970-224-6134fax
Uwe,
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� �. . as owner(s) of record oil.he property located
At:
J�� E (�Gt�f SUS �c7
Fort Collins, Colorado, hereby declare and attest
to the following: (please check only the one that applies):
OPTION -:
❑ 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
wall be my/our primartr residence. I/we have not personally constructed any other new homes
in the Fort Collins city limits within the past 24-month period.
OPTI[OlY 2:
:�I am/vve 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 primarlr
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 primary residence. I am aware that I/v✓e
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
contus) supervising unpaid volunteers (see Option 3 for attached dwellings). The work is directly related
12 inuo
con treldhop �-If the '3bove=referenced home; which is described more fully on Permit Application #
(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 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 t✓otar, Public
C ✓�
� !,moo„
'Ov: er Co-owner
he foreQoiny Affidavit was acknowledged before me e~ this ! 9 day of
(month, year) by
Witness my hand and of iaal seal
My commission ex'ires
KAREN THARP Notary Public
NOTARY PUBLIC
STATE OF NOTARY 10 COLORADO
L
Y COMMISSION EXPIRES JULY 23, 2010 �eVlSed �i,✓1/L�1!'