HomeMy WebLinkAbout2401 Research Blvd - Affidavits/Owner Authorization - 06/03/2014City of Planning, Development & Transportation
Fort Collins 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) _At" X, jLam- r 0&&L" CsulR6 owner of record (property
address) Z'{CI !EU-�iLA Zc,N l-v., known as (name of
business) 3= 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.
,0( I am giving permission for interior work only. The scope of the work shall be
limited to:
(�OC'.�. �3 •�i' �T�11L�Lhl� ��^-- Rah lii=F'lcE Ad.Ev4_
❑ 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:
( roww nam4~PtW)
The foregoing affidavit was acknowledged before me on the day
daylof
Gt o-e— P��Y (month, Year) byfor the purpose th ein set forth. %!
Witness my hand and of6dal seal.
My Commission expires:
Permit #
offlea use: A*
KATHI L MCDONALD
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID 200 W5075
y Commission Expires February 12, 2016
0