HomeMy WebLinkAbout6315 FALL HARVEST WAY - AFFIDAVITS - 10/13/2017Fort Collins
Building Services
PO Box 580
281 N College Ave
Fort Collins, CO 80524
970-416.2740 phone 970-224-6134fax
HOMEOWNER AFFIDAVIT
I/we, I(/ > J as owner(s) of record of the property located
At 5 W( , 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 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
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
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 m the presence of Ngtary Public
Co-owner
The foregoing Affidavit wa/acknowledged before me on this13 +�' day of
l�P 20 17 (month, year) by 62 l441
Witness my hand and official seal
My commission expires
CORINA HARTZOG t4btary Piibfic
Notary Public
State of Colorado
Notary ID # 20174008848
My Commission Expires 02-27-2021
Revised 611012014