HomeMy WebLinkAbout1301 University Ave - Affidavits/Owner Authorization - 04/25/2012Flirt Collins
Planning, Development & Transportation
281 N. College Ave P,O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-613
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT B12-02267
I, (Print) Led &'&. 6u�q - attelre Nnjaef%iq 4xv. as owner of record (property
address) known as (name of
business) o gs5x, hereby authorize the
13e1 UKivert�
work listed below to be done on Laid 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
I am giving permission for interior and exterior work. The scope of the work shall
n
limited to : PLar ntf F/LAry��C �TRKSgg� QpcF�� Zi��, �s SI nlYlT A �c� i
(Property own signature) ( Property owner name, please print)
The foregoing affidavit was acknowledged before me on they day of
fto-i I (month, year) by L. D ll 10,.,6L A�
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires: 10 •14 •(Z
Permit #
Office use only
-'; �AA
Nota u is
SANDRA BICKERTON
NOTARY PUBLIC, STATE OF OOLORADO
My Comm. Expires 10114/12