HomeMy WebLinkAbout110 E Oak St - Miscellaneous/Owner Authorization - 06/05/2007Community Planning and Environmental Servic$ 0 703 592
ift Fort Collins Neighborhood & Building Services
City of Fort Collins 281 N. College Ave., P.O. Box 580; Fort Collins, CO 80522-0580; Voice: 970 2216760 FAX: 970 224 6134
OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) 1) 0 517A 5 1 D L L C— as owner of record (property
e o Iii1 Iq 12 [c L • Ian (� 6 VV) 2 .
Address) A I � p8 NYd.N AA Ui A 7-oc7 known as (name of
business) 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
❑ I am giving permission for exterior work only. The scope of the work shall be limited
to
I am giving permissiop for interior and exterior work. The scope of the work shall be
limited to RA VVY Al o Sp�-Cf pyv! ? R 9 4- %R
[ O tq J `r- Da9 K� �oyC
(P perty 6wnef signature)
The foregoing affidavit was acknowledged before me on the 5 ~" day of
amA&L, ?fx:lrt (month,year) by Mse44 -4wb
for the purpose therin set forth.
Witness my hand and official seal.
My commission expires: ('z-yp-pC` /
A
Notary Public
Permit #
(office use only)