HomeMy WebLinkAbout4803 Boardwalk Dr - Affidavits/Owner Authorization - 06/01/2017City of Planning, Development & Transportation
Flirt Collinsll281 N. College Ave
", Fort Collins, CO 80524
B A*% ffA%Phone 970-416-2740 Fax 224-6134
7UE7 12 -
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) I'F50 S HA8-t(A) &IM 4) as owner of record (property
address) L/ 0-3 � l: 6141I >5 known as (name of
business) A SP6N 50PA-f )` L.L,G 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
0, I am giving permission for interior and exterior work. The scope of the work shall
limited to :
(Property owner signature)
(Property owner name, please pent)
The foregoing affidavit was acknowledged before me on the day of
L
t�l 20 (month, year) by 1'�`�/1S i�14 �1 � — JD
for the purpo therein set forth.
Witness my hand and official seal.
My Co
MELISSA NELSON �Q
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID # 201640103101 Notary Public
MY COMMISSION EXPIRES 03.14.2020
Permit #
Office use only