HomeMy WebLinkAbout2545 Research Blvd - Affidavits/Owner Authorization - 08/02/2012Fort Collins
Planning, Development & Transportation
281 N. College Ave
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+6134
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) KdM , iy�lerNr i�r�c�or �•1� tSi�t-as owner of record (property
address) aSq S known as (name of
business) 1hr&1ccU&Xk 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:
❑ I am giving permission for exterior work only. The scope of the work shall be
limited to:
iL I am giving permission for interior and exterior work. The scope of the work shall
limited to : •
Vabe::.4 LY,4- ler�vh��ecia� ietl�Si
(Pro dPownerna e,• p/ease�ppn[) A
Colorn.da S+Tj1f-UAA1%*(Si 3Carcll
The foregoing affidavit was acknowledged before me fl% pe _ day
/ (month, yet)
for thd purpose therein set forth.
Witness'my hand and official seal. �OSABY Os
My Commission expires: "�eo;�,al • PUB��G 0��
��'riRlF OF
Permit* >
Office use only