HomeMy WebLinkAbout632 ENDICOTT ST - AFFIDAVITS - 7/11/2016Fort Collins
Building Services
PO Box 580
281 N College Ave
Fort Collins, CO 80524
970-416-2740 phone 970-224-6134 fax
wi! �(_'z ]� L HOMEOWNER AFFIDAVIT
(� CLG eS� + 1/US fee cL ve�i
I/we, (Z�jn s'-t-a vase . ���.f s, +-v�Lp s tee , as owner(s) of record of the property located
At: 632 t 6dr co•i-+ 5t- 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:
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 andmy/our personal primary
residence. ►ni i l j b v
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/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
r_Pont0upugly supervisingunpaid volunteers (see Option 3 for attached dwellings). The work is directly related
o the construction=dithe ab i 01,referenced home, which is described more fully on Permit Application #
�` 4obtdined4fom 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
.a. 71100 Jl" i• ' l
The foregoing Affidavit was acknowledged before me on this
JL (month, year) by
Witness my han nd official seal
4A
Co-owner
day of
My commission expires: ►r®
MARIA L. REYES otary
NOTARY PUBLIC, STATE OF ILLINOIS
My Commission Expires 0412312017
vised 611012014