HomeMy WebLinkAbout820 Merganser Dr - Affidavits/Owner Authorization - 07/19/2013Fort Colhns
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 PERMIT
`i', (Print) BAU PUJA 1' fed' I V Sk-�0 as owner of record (property
address)20 U 4 &1 SOY- D •l-@A 001110 �(L �U511}_ known as (name of
business)< <GU 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 shail.be
limited to:
0 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
limited to :_ V7f P6.Cv ;� n-� bVVOelA Lk,K i �S
IILW,414 n Col� 11a4l I
roperty owner name; please print)
The foregoing, affidavit was acknowledged before me on the day of
T�L (month, year) by_{,birP I'l�t i'ril I Vl
for the p4pose therein setforth.
Witness my hand and official seal.
My Commission expires: 312Co JZD ri.-
Permit#
o(flce use only
Commission + Y015bdb
Notary Public - Cdlfortils
los Angeles County
i DPP .2461,,ke,(fGlcizuuilyd.�rnevr� J
ACKNOWLEDGMENT
:State of California
County of 4--OS V mo1-P, �e S )
On ZO IS before me,
(insert name and title: of the officer)
personally appeared. V-Uk:re k k r�' QOWO(kS
who proved to me on the basis of satisfactory evidence to be the personWwhose name(s)
subscribed to the within instrument and acknowledged to me that be/she/thW-executed the same in
Wher/Jhe authorized capacityW), and that by Jais7her/their signature(sron the instrument the
persoriK, or the entity upon behalf of which the perso%Wacted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal.
J
�r2Signature It
(Seal)
DONI Commission
20155 I
�a
Commission iM 2015545
Notary.Public - California
zLos Angela. County
My Comm. Upiras Mar 2& 2C