HomeMy WebLinkAbout3519 Richmond Dr - Affidavits/Owner Authorization - 08/13/2012e'A,U�. 11 20121: 1:29",Vr''��"'ASSOCIATE S GRUBER CONSTRUCTIOFJ NG. 5440 F. 2- 02'62
Community Planning and Environmental Services
Building and 7oniag Department
City of Fort Collins
OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL,
BUILDING PERMIT
I, (Print) " QYv>�S vo as owner of record (property
Address)"'
Ad3 �� �1 119�i �O �oSa7J
� � � _" 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,
1 I am giving permission for interior work only. The scope of the work shall be limited
- to � /�42L mr R AkrJ ate' cT, f ,wr aurzc*� , h ,a �'e
❑ I am giving permission for exterior work only. The scope of the work shall be limited
to
o I am giving permission for interior and exterior work, The scope of the work shall be
limited to
ILI
er
The forego")g affidav t nowledged before
(month,year) by
for the ourpose erin 'et forth.
Witness my hand and official seal,
My commission expires: 0-, 01 f 2vik.R
Permit m
(office use only)
F`.RQDR�GG
the l ..day of
r CO
¢' �o
:p
....PUB OF G��O
Notary Public
28", North College ,venue • P0. Box 580 • �o.t Collins, CO 805?2-0580 G* (VO) 221.67uV • FAX (4;, ,