HomeMy WebLinkAbout1103 W Prospect Rd - Affidavits/Owner Authorization - 01/08/2014F6City of 0 Planning, Development & Transportation
rH. �m�x r4 0 1����N� ollege Ave
Phdty170-416 27404 Fax 224-6134
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) C �eroe f as owner of record (property
address) 1103 wh4 Project} ICood {o'j ��`�•�, known as (name of
business) A, k a 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:
dam giving permission for interior and exterior work. The scope of the work shall
limited to : {� r r rI4 (% .f+ t' G
signature)
+3erCL t r Spero c
(Property owner na e,• please print)
1r+
The foregoing affidavit was acknowledged before me on the X
day of
SA'N 4Ytj • (month, year) by
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires: 10 IgI zoi-)
Permit #
Office use only
U)%l
Notary i