HomeMy WebLinkAbout4403 MONACO PL - AFFIDAVITS - 5/17/2017ort C®Wns
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1,' 1 F, rvices
PO Box 580
281 N College Ave
Fort Collins, CO 80524
970 416 2710 phone 470-224 6134 fax
/ MOMEOWNER A6= h= ILWV� [
I/we, 2MS i< i� �l 1� � as owner(s) of record of the property located
At 7�0 4�zDd /'PJ � , Fort Collins, Colorado, hereby declare and attest
to the following (please check only the one that applies)
11111"fWl"
❑ 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 consti ucted is on the above property and
will be my/out primary residence I/we have not personally constructed any other new hornes
in the Fort Collins city limits within the past 24-month period
OPTION 2
/111/1 am/we are acting on my/our behalf for the purpose of obtaining a building permit and
personally constructing an alteration of addition to my/our house, acting as our own genelal
contractor The house to be altered is on the above propei ty and is my/our personal prima
ry
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/oui attached single family dwelling
unit The house to be altered is my/our personal pimri residence I am aware that I/we
cannot do any structural, electrical, plumbing or mechanical work and must hire
contractors/subcontractors who aie currently Ircenbed 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, of will be
continuously supervising unpaid volunteers (see Option 3 for attached dwellings) The work is directly related
to the construction of the above referenced horse, which is described more fully on Permit Application 11
_,b!! 1!$(0� (obtained fiom the Building Services office)
I/we understand that any person(s) or agent(s) contracted to perfoim 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 failuie to comply with any of the above conditions may result in revocation of any permits
associated with the above Permit Application ntrinl)er, forfeiture of any fees that have been collected, a Slop
Work Order and potentially a court summons
Sign in the presence of Notary Pubhc
Owner
The foregoing Affidavit was acknowledged before me (on this
� 'z/ (month, year) by lam[ ru
Witness my hand and official seal
My commissio e
LISA V OLSON
Notary Public
State of Colorado
Notary ID # 20124064930
My Commission Expires 10-19-2020
Co-owner
day of
i1
Revised 611012014