HomeMy WebLinkAbout205 N College Ave - Affidavits/Owner Authorization - 04/01/2015F®rt of
Planning, Development & Transportation
281 N. College Ave
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) �'Je �r h,.s cJ C W .rt k,ti" as owner of record (property
address) l� (' S � (f :az A z-L known as (name of
business) Cho ((�g- ( oU n Pr ry! P e,, L L C-- 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
)Kf I am giving permission for interior and exterior work. The scope of the work shall
limited to : /t/utr;� / c.,liy�.�.�...t�� ass�GJ��'�/ .,�5�%%W�2_
�f_ InJL �/(—iN GOO/� .�.•rl M iy�N? n a 7°Li /✓i n.t��lr� • J
(Property owner signature) (Property owner name, please print)
The
� foregoing affidavit was acknowledged before me on the i 5T day of
9'IU (l \ : 7-0 � � (month, year) by
fort e— purpbse therein set forth.
Witness my hand and official seal.
My Commission expires:
Permit #
Office use only
ZIU441--� 1 -
N46-tarylkilic
ASHLEY B MEIER
NOTARY PUBLIC^
STATE OF COLORADO
L
MM , OND 2013403p982
EXPIRES MAY 1p 2017