HomeMy WebLinkAbout2121 Midpoint Dr - Affidavits/Owner Authorization - 03/13/2015City of
Fort Collins
Planning, Development & Transportation
281 N. College Ave
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
BUILDING OWNER AUTHORIZATIION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) /1^t f4l l as owner of record (property
address)
21 Z ` d� �r�F ��•
�^ '` �D
known as (name of
business)
^!� x "'r""(
Eh (� s9 sr t_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.
JEJ I am giving permission for interior work only. The scope of the work shall be
limited to:
jh-f.e,r.'or °'T4-tea r'z N., del 0-ti4 jli"F4
❑ 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
limited to :
-r' r- ' AL"�
(Property owner signature)
(Property owner name; please print)
The foregoing affidavit was acknowledged before me on the « day of
%yJ�rck 2a15 (month, year) by �ar/;s l�i-1'-111e '1
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires:
Permit
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cOtfrce use bhiY
i�r
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Not Pri c—
JACQUE JENSEN
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID 19994010064
MY COMMISSION EXPIRES APRIL 13, 2019