HomeMy WebLinkAbout425 W Prospect Rd - Affidavits/Owner Authorization - 05/22/2013Fort Collins
Planning, Development & Transportation
281 N. College Ave
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING P RMIT
I, (Print) C' �S as owner of record ro e
(P P i'tY
duuress) 7,A--•�/ w��l-���;,�,�G� /� known as (name of
business) 11141''/ 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:
I am giving permission for interior and exterior work. The scope of the work shall
The foregoing affidavit was acknowledged before me on the
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires:
Permit #
Office use only
(month, year) by
Notary Public
....... .......... ...� yun'l
day of