HomeMy WebLinkAbout1 Old Town Sq - Affidavits/Owner Authorization - 04/30/2014Planning, Development & Transportation
281 N. College Ave
Fort Collins, CO 80524
3 hone 970-416-2740 Fax 224-6134
4 00""' 2 1 U
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) JUOmu, [.orb 0&4t /ouc as owner of record (property
address
business)
as (name of
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.
14 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
❑ I am giving permission for interior and exterior work. The scope of the work shall
limited,to
signature)
(Property owner name; please print)
The foregoing affidavit was acknowledged before me on the 30day of
(month, year) by d 1 a e ✓-
for tfiLl purpo a therein set forth.
Witness my hand and official seal.
My Commission expires: 1 c)-I 14), DI'`
Permit #
office use only