HomeMy WebLinkAbout5529 S Timberline Rd - Affidavits/Owner Authorization - 04/27/2017City of
,F6rtCollins
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
I, (Print)_as owner of record
(Property
address) SSZ9 Ti.>,.� L1 2A)j known as (name of
business) W'Llh Qp ubC �✓ ENTER 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:
I am giving permission for interior and exterior work. The scope of the work shall
limited to : WDelr I s Ays r
(Prooertyownersigna u )
Property 6wnername, plea--,- pant)
Thee, foregoing affidawt,was, acknowledged before me on the 17 day of
T 2t'.1 i 2D 17 (month, year) byt' .1= SI (Yi V) S[5 i'1
for the purpose therein set forth.
BRITTANY .'` P i.L bROwN
Witness'my hand and official.seal. NOTARY PUBLIC
STATE OF COLORADO
My Commissioh expires: _ O(,3 NOTARY ID 20i/4919392
>20 .I MY COH:11:;5:", .:U APRII 9„ 2018
PermB 164,