HomeMy WebLinkAbout4862 Innovation Dr - Affidavits/Owner Authorization - 01/16/2011Communih Planning and Environmental Serx iceir
Budding and Zoning Department A /
City of Fort Collins
OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I (Punt) / as owner or record (proper I
Address) -0344 /.. j Tom... a known as (name of
business) Qe..g,.,,.. hereby authorize the work
listed below to be done on said property I understand that such worn 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 snall be limited
M
o I am giving permission for ex enor work only The scope of the work shall ce limited
to
I am diving p- mission for interior and exterior work The scope of the wor< shall be
limited to
-+ A6a•J;p / 1c.rluw
(Prop rty o lner signature)
T e foregoinpthenn'let
vs acknowledged before n ontthe day of
(month year b
f the purp forth �" {— `cnWu�OZNTse,erq
� cHklsi I ' I rnoRAry 1{jj
Witness my hand and official seat NOA'k PUBLIC
STAfi t)LORADO
hl/commission a pirz_ alaq log (�uA,
HComa ss rr L nUes�
L i'K,m
Notary Public
Permit 0
(offic isconly)
i i C II e jt et tie i t i; iY odU For i roDi rn i>> 0 0 it, 0) n i o i i\ iti Q
el