HomeMy WebLinkAbout4321 Corbett Dr - Affidavits/Owner Authorization - 07/13/20160
FCity of Planning, Development & Transportation
ort o,Rins;. 281 N. College Ave
Fort Collins, CO 80524
l Phone 970-416-2740 Fax 224-6134
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) as owner of record (property
address)_ 6OWis1 as (name of
business) i ?t.,j >`� : � i'3u , �-1�17 L 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:
��, am giving permission for interior and exterior work. The scope of the work shall
limited to : A)d h i.-q j
..1._..- -V ,
(Property owner
(Property owner name; please print)
i,/r? r..
The foregoing affidavit
�was acknowledged before me on the I day of
(month, year) by��. ; K�7��
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires:
Permit #
Offilce use only
LAURIE GARNER
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID 0 20054044396
MY COMMISSION -EXPIRES DECEMBER 02_2017