HomeMy WebLinkAbout1136 E Stuart St - Affidavits/Owner Authorization - 11/10/2009�F�ort of
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) �i!6�r, &-g-roLE- 7 r' as owner of record (property
address) /136 0-- I05--A known as (name of
business) `/ S/Ev !�i ���r 11--f 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
X 1 I am giving permission for interior work only The scope of the work shall be
/) ,/ A --/ �n
limited to
- Z,2,e r4-0 i h
O 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
-SKr 77,
(Property owner name, please print)
The foregoing affidavit was acknowledged before me on the/0-j_L� .da}y-of
2D09 (month, year) by (�l i Ke,e-
for a purpose therein set Forth
Witness my hand and official seal
,�P'`tY P(/e
My Commission expires
9'-Z010 ?O <
809071 ? KRISTI H
JRTOLETTE
.w
Permit #
Office use only ®Wti _;
No ry Put &
ET/b0 3917d ANAS 1SN00 3131dW03 8T8TLLE0L6 91 ET 600Z/0E"0T