HomeMy WebLinkAbout146 N College Ave - Affidavits/Owner Authorization - 10/19/2011City of
Z,F,,®o�rt 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 PERMIT
I, (Print)
)� �\4►-"
r��
as owner of record (property
address)"
known as (name of
business)
+ _kc,
A:S+Z)!-� C'L-
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: e7 i2
1 f
XI am giving permission for exterior work only. The scope of the work shall be
limited
I am giving permission for interior and exterior work. The scope of the work shall
limited to
rope owne signature)
(Prop � owner name; please print
`The foregoing affidavit was acknowledged before me on the 1 day of 2�' .. %
MARY ANN
QL40 bl? r, �) (month, year) by , T. Q n nG1,h : •
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires: 1 Q- 1- CX1 4-
Permit #
OfFce use only
Notaly •,!
109552