HomeMy WebLinkAbout1725 E Prospect Rd - Affidavits/Owner Authorization - 10/07/2016City of
Planning, Development: & Transporltaflon
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) on 4 S ,` as owner of record
(property
p Kv
address) �� E. 96=C� M', F�C� J Ca `�SaSknown as (name of
business) u� Cev��cP u c. Qnr-AkQAy\ Upfck-An 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 Unteriou" work oenUy.' The scope of the work shall be
limited to: Xis 1'y ,, Al a4l - c 0A o /3EA /2 / q/�f W,gLL
/?FH0 ✓4 L r a �'RZT's1/2 u �, Opc.1Vj,✓
❑ I am giving permission for exterior work ooniy. 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
(Property owner signature) (Property owner name; please print)
The foregoing affidavit was acknowledged before me on the -I4, day of
(month, year) by 9-1�0s-'—KOASyyvk-\ r--
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires: W\\ a51 Qon
Permit #
Office use only
%AO-4&— -A AJO�
Notary Public
SUSAN E. NELSON
NOTARY PUBLIC
STXrE OF COLORADO
NOTARY ID 20134026589
MY COMMISSION EXPIRES APRIt 25, 2017