HomeMy WebLinkAbout221 Jefferson St - Affidavits/Owner Authorization - 05/23/2011City of �
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� �nning, Development & Transportation
�81
0r O`l's
N. College Ave P.O. Box 580
Fort Collins, CO 80524
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Phone 470-416-2740 Fax 224-613
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) C>v as owner of record (property
tl
address) known as (name of
business)
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.
U. 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:
I am giving permission for interior and exterior work. The scope of the work shall
^limited to : �Ik4tri �Caat+� ,c� su�r
name; please print)
The foregoing affidavit was acknowledged before me on the o 3 day of
— (month, year) by _-k-ilL1C4 461for the purposaftherein set forth.
Witness my hand and official seal.
My Commission expires',%
Permit #
Ofrice use only
Public
MY
JILL G.
MULL&
kO
F COO
MYCOMMI EXPIRES
SEPT. 02, 2012