HomeMy WebLinkAbout425 W Prospect Rd - Affidavits/Owner Authorization - 12/06/2010Fort Collins
Planning, Development & Transportation
281 N. College Ave
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING P RMIT
I, (Print) ��+4�+� �� a as owner of record (property
address) '�Z� known as (name of
business) ` • �"a-� hereby authorize the
work listed below to be done on said property. I understand that such work will only be
performed 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:
tNKr I am giving permission for interior and exterior work. The scope of the work shall
limited to :
(Property owner name; please print)
The foregoing affidavit was acknowledged before me on the day of
D,, 12010 (month, year) by �� � L �, �r n P T 7-
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires:
o�;L- / R- a0/3
01007703
Permit
Office use only
Notary Public
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RUB LIC O
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