HomeMy WebLinkAbout1933 Jessup Dr - Affidavits/Owner Authorization - 05/28/2014E
City Of Planning, Development & Transportation
Fort Collins 281 N. College Ave
ort Collins, CO 80524
q'Qhone 970-416-2740 Fax 224-6134
4 o e. ""t
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) JfSSvxp Ny-M L1.( as owner of record (property
address) 19,56 JeSav p --064e known as (name of
business)(MeC 'CxyN ,S Jesup TgYm {Vc-\'6&'n VI)had eby 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:
❑ I am giving permission for exterior work only. The scope of the work shall be
limited to:
Ii I am giving permission for interior and exterior work. The scope of the work shall
limited to : CO'(e `% �k i " Ti-"U V �IYlA5l1
(Property owner signature)
�u->w Q V--x ` I LL<
)DI lay M Ukyrg)a Cc ` (YYX`ce4eQ '
(Property owner name; please print)
The foregoing affidavit was acknowledged before me n the 2� day of
14 (month, year) by
for the p rpose therein set forth.
JENNIFER FELLINGER
NOTARY PUBLIC
Witness my hand and official seal. STATE OF COLORADO
NOTARY ID 20044044223
My Commission expires:
MY COMMISSION EXPIRES 07/17/2017
� _ � �, ' � ; _ �- _
Nol& Public
Permit #
Office use only