HomeMy WebLinkAbout132 Laporte Ave - Affidavits/Owner Authorization - 05/10/2016Fort 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) L--QPN- c VeAtAC as owner of record (property
address) C3 L4&-k, &U/tk known as (name of
business)LL,,,I, 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.
Q""I am giving permission for interior work only. The scope of the work shall be
limited to: jet eSS� � Z�f d0'2n- a'-4
r lo""VV , A441 La " -S
❑ 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 :
' elf--D : -e. V1Au.c. LLr(,
owner sin ure) (Property owner name, please print)
The foregoing affidavit was acknowledged before me on the /6
�4k day of
�� d-0 I 1p (month, year) by
for the p rpose therein set forth.
Witness my hand and official seal.
My Commission expires:
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cam_
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Permit #
Office use only
JANELLE STULTS
NOTARY PUBLIC
STAVE OF COLORADO
NOTARY fO 20094012518
MY COIMA 18SION EXPIRES APRIL 21, 2017'
Public