HomeMy WebLinkAbout3325 S Timberline Rd - Affidavits/Owner Authorization - 04/06/2016Fort 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) 3325 ,�3Utb "I w loa h ►1 c LLG as owner of record (property
address)'.3325 S 11.1MIDW-li'I2, Rd-E".Cbllil'1S,C,0 WD known as (name of
business) "Thy- K.l eei'1 a-n ez'n-)Mnt 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
m_. 1.tnf_
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 :
owner signature)
roperty owner name, please print)
The foregoing affidavit was acknowledged before me on the day of
Ng);L 9 9 9
2c 1 l.P (month, year) by LA ar\ b 1 Ws
fdr the purpose therein set forth.
Witness my hand and official seal.
My Commission expires:
No ry Pub "c
Permit #
Ofce use only
MICHELLE K MORTENSON
I NOTARY PUBLIC - STATE OF COLORADO
Notary Identification #20084016857
My Commission Expires 5/19/2020