HomeMy WebLinkAbout143 Remington St - Affidavits/Owner Authorization - 10/10/2012City, of t Planning, Development & Transportation
Flirt Col`ins 281 N. College Ave
`., Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) Tr !gke, Di P. 0 as owner of record (property
in
business)
known as (name of
hereby authorize the
work listed below to be done on said .property. I understand that such work will only be
performed 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:
I am giving permission for exterior work only. The scope of the work shall be
limited to:AL.% i K (_ n Q S
❑ I am giving permission for interior and exterior work. The scope of the work shall
limited to :
(Property owner signature)
11-icin
(Pri rty owner name; please print)
The foregoing affidavit was acknowledged before me on the o - % day of \/
De - To be tt r ?,o t Z (month, year) by —91 c 1 4:
for the purpose therein set forth.
Witness my hand and official seal.
My Commissiorrexpires: 3' ph I i (P
Permit #
Office use only
"6
Notary Public .
8. SCOT SIMMONS
Notary Public
State of Colorado
4