HomeMy WebLinkAbout1119 W Elizabeth St - Affidavits/Owner Agent - 03/11/1999MAR-10-99 03:28 PM
P.01
Building &
•
Zoning
Dept.
281 N. Cot+ege Avonu QQ°°� 5
FortCollins,Coloraeo!•g5
Community Planning and Environmental Services
Phone: 970 221 6760 9 2 4
BUILDING OWNER OR BUILDING OWNER'S AGENT/
EMPLOYEE CONSTRUCTION AUTHORIZATION AFFIDAVIT
(PLEASE PRINK
lTWTM-
as owner(s) of record of the property
� r II
located at: � . �9-) Q. 5 W • �/r 2dfe�/� Fort Collins, Colorado, hereby declare and attest
to the following.
L7 I am/we area g on mylour eh
for the p ose of obta in
a bu tling permit r minor /a(rations
to the buil ' g referenc above. I am/ are person perfor "ng allof th ork as d d on
permi pp # ; or t /
❑ f/we do authorize l P� /) n �( r>> ld �/s, (Agent) to act on
my4wf behalf for the pur ses of obtaining a uilding permit for minor alterations to the building
referenced above. Said Agent will be personally performing ail of the work as described on permiVapp
!!we understand that the Agent named above is4W a contractor and iWny asw employee as defined by
Furthe . Ilure under Land that p ent of su fees or comp nsation fort above wor to any pt r
w<hs not my! employee s prescribe by Colorado w, constitut a "constru on contract" nd
esthe ntractor Li se provisi s of the Fort oilins Code rd will res to revocati of theaper d.
Owner Owner
Agent
STATE OF COLORADO )
)ss.
COUNTY OF LARIMER )
°The -for ing•Aff(d it was acknowledged before me this day of MArA -
19-IL, bye°-
Witriessmy"4iand and official seal.
MrCommission expires: 1-26-40
��-
N ary Public