HomeMy WebLinkAbout3500 S College Ave - Affidavits/Owner Authorization - 07/30/2015City of
Planning, Development &Transportation
281 N. College Ave P.O. Box 580
For Collins, CO 80524
Phone 970-416-2740 Fax 224-613
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) e-,at.cwe—
Shopping
LLC
as owner of record (property
address) %
S 5 . CoN'a
e- Pryey R .
Co N nS
known as (name of
business)
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
XI am giving permission for interior and exterior work. The scope of the work shall
limited to :
(Propem/ owner signature)
S9tare Sh6ppf',Iy e✓ LC c
(Pr erty owner na , pi se print)
The foregoing affidavit was acknowledged before me on the �t" day of
2bi S (month, year) by
for the urpose therein set forth.
Witness my hand and official seal.
My Com�
'I P^AfiGARET R. CLANCY
NOTARY PUBLIC
sTATE OF COLORADO
NOTARY ID # 20134040425
r!Y COMMISSION EXPIRES AUGUST 06. 2017
Permit
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