HomeMy WebLinkAbout1250 E Magnolia St - Affidavits/Owner Authorization - 08/02/2013Cityof
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-613
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print)
business)
of record (property
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.
0, I am giving permission for interior work only. The scope of the work shall be
❑ 1 am giving permission for exterior work only. The scope of the work shall be
limited
❑ I am giving permission for interior and exterior work. The scope of the work shall
limited to :
,r
P ownersi nature
(Property owner name, please print)
f i .�10K /
The foregoing affidavit was acknowledged before me on the day of
1 (month, year) by o Q_. �-
for the orpose therein set forth.
Witness my hand and official seal.
My Commission expires: b
Notary 6b is
Permit #
ice use only TERI S. HITE
NOTARY PUBLIC
ESenton County. Arkansas
ommission Expires 1/5/2021
mission Number 12380223