HomeMy WebLinkAbout913 ELM CT - AFFIDAVITS - 5/24/2018"i-t Collins
Building Services
PO Box 580
281 N College Ave
Fort Collins, CO 80524
970-416.2740 phone 970.224.6134fax
/// / / HOMEOWNER AFFIDAVIT
� /�� I�rr L, d l d l u �17'eZ J r as owner(s) of record of the property located
At _ -( / 3 G� C�- , 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 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 dity limits within the past 24-month period.
OPTION 22
j4( I am/we are acting on my/our behalf for the purpose of obtaining a building permit and
personally constructing an aeration 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 primarr
residence.
OPTION 3:
❑ 1 amMre 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. 1 am aware that Vwe
cannot do any structural, electrical, plumbing or mechanical work and must hire
oontractore/subcontrectore 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).
Vwe 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.
Vwe 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 cougf summons.
S
The foregoing Affidavit was acknowledged before me on this
(month, year) by
Co-owner
day of
Witness hand and official seal
My commission expires:
Notary Public
Revised 611WO14
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CALIFORNIA NOTARY ACKNOWLEDGMENT
For An Individual Acting In His/Her Own Right:
A notary public or other officer completing this
certificate verifies only the identity of the individual who
signed the document to which this certificate is attached,
and not the truthfulness, accuracy, or validity of that
document.
State of California )
ss.
County of p5 S )
On -ZOiq before me, }� • 6a, �V�2 Notary Public, personally appeared
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the
within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized
capacity(ies). and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of'
which the person(s) acted, executed the instrument.
I certi ly under PENA LfY Of' PERJURY under the laws ofthe State of California that the foregoing paragraph is
true and correct. �1
WITNESS my hand and official seat
04 GALVEZ'�i,�
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[NOTARIAL SEAL]
My commission expires: V �� s ,�G•) 1
HEL6850CA (1 /I 5)