HomeMy WebLinkAbout2121 Midpoint Dr - Affidavits/Owner Authorization - 10/09/2015r : f<. -111 IT:—``� 9 . rya
City
Planning, Development & Transportation
281 N. College Ave
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
BUILDS, NG OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUELDING PERMIT
I, (Print) -" P3"r5o&-5 as owner of record (property
Co 80sw5
address) 2121 [A"ka�¢� f Lf rs: �o f vorf ! a5944sz known as (name of
business) �A lid sots ?— (.rroN l11ei Sac&vwce� hereby authorize the
work listed below to be done on said property. I understand that such work will only he
performed contractors licensed by the C tV of Fort Collins.
KI am giving permission for interior work only. The scope of the work shall be
limited to:
❑ I am giving permission for exterior worts only. The scope of the work shall be
limited
❑ I am giving permission for interior and exterior work. The scope of the work shall
It'�Ii MU875
(Propeiiy oxinersignature)
The foregoing affidavit was acknowledged
c_Zylcj (month,
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires: to 13 f zoo?
Permit# B ISO71 IZ
offire us, sty
&"I pa.-Yjoua5
(Property owner name; pleaseprint)
before me on the ` day of
year) by '\A�f�X ! )S