HomeMy WebLinkAbout4380 Ziegler Rd - Affidavits/Owner Authorization - 06/16/2011City, of Planning, Development & Transportation
F�i l �� Ins 281 N. College Ave.
''� � j Fort Collins, CO 80524
6 5 9 Phone 970-416-2740 Fax 224-6134
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) __[AA WAY as owner of record (property
address) _050 21c:6� g7 known as (name of
business) q/&C.0 hereby authorize the
work listed below to be done on said property.. I understand that such work will onty'be
performed contractors licensed by the City of Fort Collins.
Ca' I a. giving permission for interior work only. The scope of the work shall be
limited to: %IT&LIVIL _C®JfMtCr'9 44 ail: &w_ La&A
0 1 am giving permission for'exterior work only. The scope of the work shall be
Limited to
0 I am giving permission for interior and exterior work. The scope of the work shall
limited to, r
"C45 Crt/o►
slgnafure� (Property owner name; p/ease prfnt)
The foregoing affidavit was acknowledged before me on the day of
au (month, year) by e_ /"1`` VG,rs,q&eI.._
for purpose therein set forth.
Witness my hand and official seams
My Commission expires:
r
OF
-
` .fj• Nota Public
Permit #
---Ohyce ISSION -
D(PIRES:
,Ady 23.2011