HomeMy WebLinkAbout200 Jefferson St - Affidavits/Owner Authorization - 04/10/200211:14 FROM CMC VAIL TO 19704725225-3108 P.01/01
Comm Lty Panning and Environmental Services
Building and Zoning DepartMent
OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
1, (Print) AlrajU#�-rc�/ as owner of record (property
Address) 2 O Jr. -TQg�+'&ShL 5T known as (name of
business) .aA &AW 4- P
teak hereby autho ze the work
listed below to be done an Said property. I understand that such work wAi be
peribraied only by contractors Ilcenmd by the My of Fort Collins.
a 1 am giving permission for inWor work only. The scope of the worse shall be linited
t0 WW —
*-�l am giving permission for exterior work only. The scope. of :he work shall be limited
to Luxe t4=1 kP.li�
o I am giving permission for hterior and exterior work. The scope of the work shall be
limited to
(property owner signature) r1`
The fo i 1W.d8W was acknowledged before rae on the
L 1430 . (mwrth,year) by
fnr the purpose therin set forth.
„
Wtoess my hand and official seal. q .
"�`••.L LAG•: o
My commis
si0r expires: MY iN Of • • • • • • p0
/ a u� of �o4aP
Permit 0
(o ica use Only)
1S] ?north Colieae Avenue • P.A. z= 580 • Fort Cullers, CO w2z- 580 • (e"01227.67fiO • FAX {970) 2246134
TOTAL P.01