HomeMy WebLinkAbout2107 S Timberline Rd - Affidavits/Owner Authorization - 12/04/2015kit o� 131600593
Fort Collins 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
•a
BUILDING PERMIT
t
I, (print)' `_ _ j, 161 r Ld ttP � as owner of record (property
address)-,Z)0 7 ; ' ,,, rzr 1, a �e gr r 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 to:
I am giving permission for interior and exterior work. The scope of the work shall
limited to :
(Property owner signature
,SF-- ."0-)q
(Properly owner name; please print)
The foregoing affidavit was acknowledged before me on the I /� day of
(month, year) by 1 G
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires: q—f 1-) o
Permit #
Ofirce use on1v
r
Notary Public
DIANE DANIEL
Notary Public
State of Colorado
Notary 10 19914003345
My Commission Expires Sep 11. 2018