HomeMy WebLinkAbout4380 Ziegler Rd - Affidavits/Owner Authorization - 01/07/2015Fort 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
BUILDING PERMIT
I, (Print) 9-- as owner of record (property
address) Lf;dc) Z 1 C-GL4itz. ?,2 • fCCj—Ccz.c./N S known as (name of
business) -;CI-4*W6jt—S 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 :
Ro- G-0
(Property owner name, please print)
The foregoing affidavit was acknowledged before me on the day of
a n +,, a r I (month, year) by
for the purpose therein set forth.
Witness my hand and official seal.
My Commission a pires: KATHLEENo ARY P B CNKE
STATE OF COLORADO
NOTARY ID 0 19874125544
MY COMMISSION EXPIRES MARCH 03, 2018
Permit # 131 &000
Office use only
Notary Public