HomeMy WebLinkAbout617 W MAGNOLIA ST - AFFIDAVITS - 3/19/2018City Of Building Services
Fort Collin 28 Box 580
College
sB ®� ? 1 1 For N College Ave
Fort Collins, CO 80524
970-416-2740 phone 970.224.6134fax
HOMEOWNER AFFIDAVIT
� e-
I/we, I6t"` Iv-104 yv"A-r as owner(s) of record of the property located
At: Q7 t.✓, 41y"JitA Fort Collins, Colorado, hereby declare and attest
to the following: (please check only the one that applies):
OPTION 1:
y 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 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 and is my/our personal primary
residence.
X'..111►
❑ 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).
1/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
Owner
Co-owner
The foregoing �,lr �Affidavit was acknowledged before me on this iqfday of
k I ' 0 _ (month, year) by 6m
Witness my hand and official seal
My commission
CORINA HARTZOG Notary Wblic
Notary Public
State of Colorado
Notary ID # 20174008848
My Commission Expires 02-27-2021
Revised 611012014
Fort Collins
/110 �--�
'RECEPTION #20180018223, 3/29/2018 4:30:38 PM,
1 of 1, $13.00
Angela Myers, Clerk & Recorder, Larimer County, CO
AFFIDAVIT
(as required by Section 4.7(D)(3), Section 4.8(D)(3)
or Section 4.9(D)(3) of the Fort Collins Land Use Code)
I/we, )kQWAS as owner(s) of record of the property located
at: 61 % L1i- k(4� VIlf Fort Collins, Colorado, hereby declare and attest
to the following: (please check only the one that applies)
❑ 1 am/ we are acting on my/ our behalf for the purpose of obtaining a building permit for a new,
detached accessory building to be constructed at the above -listed property. The building will be
constructed with water and/or sewer service. By signing this affidavit, I/we declare that the building
will not be used as a dwelling unit.
I am/ we are acting on my/ our behalf for the purpose of obtaining a building permit for an alteration
to an existing, detached accessory building located at the above -listed property. The alteration
includes adding water and/or sewer service to the existing building. By signing this affidavit, I/we
declare that the building will not be used as a dwelling unit.
I/we understand that using the building as a dwelling unit without approval from the City of Fort Collins will
be a violation of the Fort Collins Land Use Code and could result in a court summons.
Sign in the presence of Notary Public, record the document with the Larimer County Clerk and Recorder, and submit a copy of the
recorded document with the building permit for the work checked above.
O' ner Co-owner
The foregoing Affidavit was acknowledged before
emm}e�onn�this b 19 fday of
(month, year) by 1 Y U� t try—Vem" r
Witness my hand and official seal
My commission expires:
Notary Public
:RACHEL BESEL
ary Public
of Colorado
No020/74000833
M Comn Expires01-05-2021