HomeMy WebLinkAbout4700 Lady Moon Dr - Affidavits/Owner Authorization - 05/05/2017City of
Fort Collins
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) j I
owner of record (property
address) g700 L8� Moo1.\ M06 -F1.CA1 S Co known as (name of
business) &t,39U f-ie PcL_'f Ff F)r (1l l ir%S 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
I am giving permission for interior and exterior work. The scope of the work shall
limited to : `�Il D 105-Ropt-k aLl t_:bC) �T
signature)
(Property owner na e, please print)
The foregoing affidavit was acknowledged before me on the /� day of
_ (month, year) byy ► ►'� ! b r I t l _
for the pt6ose therein set forth.
Witness my hand and official seal.
My Commission expires: (o - 21 - .2 o 20
Permit U
Office use only
7iq 1A 14
otary ubli
TERRY L HIRSCH
Notary Public - State of Colorado
Notary 10 20034041571
My Commission Expires Jun 21, 2020