HomeMy WebLinkAbout430 N College Ave - Affidavits/Owner Authorization - 07/19/2016Fort 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
d//,ems
I, (Print) Ala doja a owner of record (property
address) �/ ,eve known as (name of
r
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 Port Collins.
4d I am giving permission for interior work only. The scope of the work shall be
limited to: Install interior mezzanine, with associated lighting & fire sprinkler
below mezzanine.
❑ 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 :
(Aqp&iy owner ature) (Propertyowner'name; p/eke pdnt)
1F C97�)�a!-ioBF`f
The foregoing affidavit was acknowledged before me on the day of
(month, year) by
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires:
Notary Public
_
Wink -A
,i
l.� J is'