HomeMy WebLinkAbout616 W OAK ST - AFFIDAVITS - 3/6/2017Re '
PO Box 580
281 N College Ave
Fort Collins, CO 80524
970-416-2740 phone 970-224-6134fax
HOMEOWNER AFF�J�AG� �
I/we, poclel, �/� as owner(s) of record of the property located
At: �/6 �.� S �� Fort Collins, Colorado, hereby declare and attest
to the following: (please check only the one that applies):
OPTION 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 primary residence. I/we have not personally constructed any other new homes
In th -ort 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 and is my/our personal rimar
residence.
1912 IlpIM&
❑ 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 horne, which is described more fully on Permit Application if
(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 condition6 may result in revocation of any permits
associated with the_above Permit Application number, forfeiture of any fees that have been collected, a Slop
Work Order and'potentialfy a court summons.
Sign in the
Owner Co-owner
The foregoipg Affidavit was acknowledged before me on this day of
lrC (month, year) by f2oaer >l ��
Witness my hand and official seal
My commission expires:
EC,ORINA:HARTZOG otaryotablic
te olorado
a®W74008W Revised 611012014
�,es 27-302n