HomeMy WebLinkAbout645 STONEHAM CT - AFFIDAVITS - 2/11/2016® Building Services
_lftns PO Box 580
F�ctryfbo_ 281 N College Ave
Fort Collins, CO 80524
970-416-2740 phone 970-224-6134.fax
HOMEOWNER AFFIDAVIT
r \
I/weas owner(s) of record of the property located
At: Ucky_ �.vv�. G� , Fort Collins, Colorado, hereby declare and attest
to the following: (please check only the one that applies):
OPTIOIN 1:
❑ 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 n� -marl residence. I/we have not personally constructed any other new homes
in the Fort Collins city limits within. the past 24-month period. .
OPTIOIN 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 primary
residence.
OPTIOIN 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 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 above 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 of Notary Public
wner. Co-owner
The foregoing Affidavit was acknowledged before me on this day of
\�Ie% Ko (month, year) by O�
Witness my hand and official seal (� a
My commission expires:
KAREN THARP Notary Public
NOTARY PUBLIC
STATE OF COLORADO Devised 611012014
NOTARY ID # 20074028171
MY COMMISSION EXPIRES JULY 23.2019