HomeMy WebLinkAbout934 S Lemay Ave - Affidavits/Owner Authorization - 08/15/2013Fort 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 PERMIT
I, (Print) !{rc/ /L(�1M1 as owner of record (property
address) 1%�� ``S 'l i ��y. �% 6///;ZS known as (name of
business) ��'+7�'� �°�'`/ ���Al 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 °�
limited to :
(Property owner signature)
A,C 16�1440r'
(Property owner name; please print)
The foregoing affidavit was acknowledged before me on the day
day of
/�yvS ao/3 (month, year) by 1�IU�-
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires:
Permit #
GRAIG BEARS
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID 200540,2954
My Commission Eypires Aug. 5, 26
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