HomeMy WebLinkAbout120 W Stuart St - Affidavits/Owner Authorization - 03/23/2017f I
�F�ort Collins
�-
Planning, Development & Transportation
281 N. College Ave
Fort Collins, CO 80524
Phone 970-416r2740 Fax 224-6134
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) RWK &91WAUSEN of 40ft FY CV4-lwS k6 as owner of record (property
address) &10 W 34 • %t+ Cofi',i is Cd 40"'Em as (name of
business) * - " C smC Cob 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.
XI 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:- I JU4.')
❑ I am giving permission for Interior and exterior work. The scope of the work shall
limited to :
ownersigroative)
MARK GoloausEN W
ZPAW A0H AUJW LL4,
(fir oww tee; vtase vrynt)
The foregoing affidavit was adawwledged before me on the � day of
(month, year) byyy, Clocj Au ri . f
for the purpose therein set forth.
witness my hand and offioal seal.
My Commission expires: 3/Se' 1Z'= 9
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Permit #
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OFFICIAL _AL
MUISSA L S,AAHAN
NOTARY PUBLIC, STATE OFILUNOIS
Nip Commission Expires Nar 30, 2019