HomeMy WebLinkAbout2121 Midpoint Dr - Affidavits/Owner Authorization - 09/08/2016FCity off'`. Planning, Development & Transportation
ort Collins 281 N. College Ave
Fort Collins, CO 80524
Phone 970-416-2740 Fax ZZ4-6134
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL.
BUILDING PERMIT
I, (Print) !l 1a" as owner of record (property
FTC BD5"I�
address)' C�Ili'a-( Al iddn&s known as (name of
business) enid - r6u a C0" ad 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:. 110J
❑ 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
2yan wi a[aykson
(Property ownersigna re) (Property owner name; please print)
The foregoing affidavit was -acknowledged before me on the day of
01 (month, year) by Awi lMA.m
for the purpose therein set forth. VICKY 0 HICKS
Notary Public
Witness m hand and official seal... Slate o! Colorado
y Notary ID 20064020678 .
My Commission expires:,
My Commtsstnn Expires :Feb 21y 201 .
Nota ublic I V'1C
Permit #
Office use only