HomeMy WebLinkAbout412 W Laurel St - Affidavits/Owner Authorization - 04/14/2015City of Planning, Development & Transportation
Flirt Collins 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) ?A�—R C'� o\ V i /\ caw\ as owner of record (property
address) LA \ `1 U • Leir,re-A 5A • known as (name of
business) V�Kk CAC,N\-r Cs k�oko oo.- \✓CA6% 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 to:
2 I am giving permission for interior and exterior work. The scope of the work shall
limited to :_ n e. W S* o 2Lrvr-, r 0,\a6t n x-L r4-L> e r\6A,
&aor I CA rran 1LA�ola\-k- �nc�.r �c��� lnrilalL inFeriyr G�
(Property owner signature) (Property owner name, please print)
The foregoing affidavit was acknowledged before me on tthe /' (�dayy of
v15 (month, year) by �crc �// d.LiL l
for the purpo a therein set forth.
Witness my hand and official seal.. ram
My Commission expires:
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