HomeMy WebLinkAbout2121 Midpoint Dr - Miscellaneous/Owner Authorization - 06/14/2007r!146M'"*N
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City of Fort Collins
; and Environmental Serv:
Building and Zoning Department
OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) fkP,ll ! n/ Yt2A 7. _A2, as owner of record (property
qp
Address) mil' % 12PI � P� s ���' U c, known as (name of
business) KUi'/Ir hereby authorize the work
listed below to be done on said property. I understand that such work will be
performed only by contractors licensed by the City of Fort Collins.
}� I am giving permission for interior work only. The scope of the work shall be limited
to Te" T Y re- Sr'�'�„ � A e, ? JS 6t % e F Su;'fP. 3 O J.
o I am giving permission for exterior work only. The scope of the work shall be limited
to
❑ I am giving permission for interior and exterior work. The scope of the work shall be
limited to
(Property ow r signature)
The foregoing affidavit was acknowledged before me on the day of
�}IAvte A-b 6' (month,year)by 1Cev;ri F_ro-g-icr
for the purpose therin set forth.
Witness my hand and official seal.
My commission expires: i/ 3 / /:2.o d 9
Permit
(office use only)
281 North CoIIoge Avenue ^ P.O. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-0760 , FA2< (970) 224-o1'4
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