HomeMy WebLinkAbout1810 W Mountain Ave - Miscellaneous - 10/29/2002Community Planning and Environmental Services
Building and Zoning Department
City of Fort Collins
OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT IZEPi2,E&=1s i _
t �
I, (Print) 5i E P14e" S��.F E ul) as owne Hof record (property
Address) 1310 \ J _ Mc)U» i Ai r-3 75LI C known as (name of
Lrst�ess)TV-Oi l-Cy Y, E9A+t 1"'z. ►�l hereby authorize the work
listed below to be done on said property. I understand that such work will be
performed only by contractors licensed by the City of Fort Collins.
❑ I am giving rmission for interior work only. The scope of the work shall be limited
to
LX'I am giving permission for exterior work only. The scope of the work shall be limited
to
UO f-rZ r1 m C 17 t)(%S i I
DV-1 L LE- I�5 TI E 12.S f
❑ I am giving permissio'r interior and exterior work. The scope of the work shall be
limited to
d?
Property owner signatu e)
The foregoing affidavit was acknowledged before me onithe da of
6 L`T`o 6-6f . QLDoa- (month,year) by t ,1-4n k
for the purpose therin set forth.
Witness my hand and official seal.
My Commi sion e4E. MATSON
OTARY PUBLIC
STATE OF COLORADOc3-OZ—
My Commission Expires Feb. 4, 2006 Notary Public
Permit #
(office use only)
281 North College Avenue • P.O. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6760 • FAX (970) 224-6134