HomeMy WebLinkAbout729 S Shields St - Affidavits/Owner Authorization - 05/11/2012 (2)Cityof p Planning, Development & Transportation
.,,�r"t,.00llins : For N. College Ave
Fort `— Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDINGInPERMIT
I, (Print) �INi �n I f� (R IdQi1 r
as owner of record (property
address) ��%% 2� '' // I5?W1 e-I 1_— D known as (name of
business) N/ 1 I Do � Q,� , K �l5—i-�m,IsQ (�ixal �reby 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
0 I am giving permission for interior and exterior work The scope of the work shall
limited to : Jjll�L(-1AJ< -aG ASS Gci I.yJpocxS
The foregoing affidavit was acknowledged before me on the day of
H 4. , , > <D I � (month, year) by % � L-Q M<
for the purposd—therein set forth.
Witness my hand and official seal.
My Commission expires:
Permit # ► 1 �� a'�
Office use only