HomeMy WebLinkAbout313 W Drake Rd - Affidavits/Owner Authorization - 01/27/2004Community Planning and Environmental Services
Building and Zoning Department
City of Fort Collins
OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print)�CO�4da-5ztt' S as owner of record (property
Address) 13 ra ke-- hIcy . known as (name of
business) c &4eby 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 As 4) %+4NS Z�1 h Mf d
❑ 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 be
limited to
(Property owner signSture)
ehip foregoing affidavit was acknowledged before me on the % da of
-u rj Lt a L" 0 !A (month,year) by
for the purpose fherin sef forth. ; JANET M. GALASSO
i
Witness my ,hand and official seal. ; NOTARY PUBLIC
0 STATE OF COLD ADO 0
My commis —lion expires: dVI� C, % fnairrfssc� Expires fl ?� pp.
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