HomeMy WebLinkAbout1600 Prospect Park Way - Affidavits/Owner Authorization - 10/22/2014City Of Planning, Development & Transportation
F®r"'t Collins 281 N. College Ave
(a Eort Collins, CO 80524
s �]n y( kl lone 970-416 2740 Fax 224 6134
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) f rOS t'2�1� i��c9✓ �Vl?YS�ti P. L-1 as owner of record (property
known as (name of
business)P. - LI�eOy'p i 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.
O I am giving permission for interior work only. The scope off the w'-or�k shall be
limited to. amod-el b? L�XiSfli�AfYTIP✓�ID����V1IJuteS �o�
❑ 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
(Property owner signature) (Property owner name; please print
The foregoing) affidavit was acknowledged before me on the � day of
kt 0O.ft ir`i W 14 (month, year) by TCkV Hak,rLot
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires:
Permit #
Office use only
Notary Public
ERICA ELLIS
NOTARY PUBLIC
STATE OF COLORADO
My Commission Expires 04/05116