HomeMy WebLinkAbout4700 Lady Moon Dr - Affidavits/Owner Authorization - 12/28/2015FortColtins
Planning, Development & Transportation
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) �r��zvyoJ I zc� as owner of record (property
address) 0 0 �CkA✓ U-\�ooyk D 1, 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
�I am giving permission for interior and exterior work. The scope of the work shall
limited to : �c. ;-�f� �— S�e�uj V�'-e,l"�
/(Property owner signature) (Property owner name; please print)
The foregoing affidavit was acknowledged before me on the C)F—P*-1 day of
oe(:E,gp Y� (month, year) by 9M,,rhCJ:!j r (ea'�Fc
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires: C� - 3- l"I
Okk
Permit #
Office use only
ASHLEY B VITALE
Notary Public
State of Colorado
E
otary ID 20134039661
mission Expires Sep 3, 2017.