HomeMy WebLinkAbout1103 S Shields St - Miscellaneous - 12/16/2003City of Fort Collins
Community Planning and Environmental Services
Building and Zoning Department
B030 .401
OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) �onJ F• SwrkN.RDw• , as owner of record (property
Address)
1 \.03 So.
Sl„e.`a5
S%
r G , Coknown
as (name of
business)
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 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
w'I'am giving permission for interior and exterior work. The scope of the work shall be
limited to ".Al. A..-- , o, &,_,74 - , �/ ., //_ 1_ - _ _
iC S ys. .e.- rrs e n p llLr�
(Property owner signature)
The foregoing affidavit was acknowledged before me on the day of
—�J� C . vv \ b 2 f (month,year) by ��o el C -SiAjc&aba2xa
for the purpose therin set forth.
Witness my hand and official seal.
My commission expires: /40�i-; 1/0
Notary Public
Permit #
(office use only)
2161 North College Avenue • P.O. Box 580 9 Fort Collins, CO 80522-0580 • (970) 221-6760 • FAX (970) 224-6134