HomeMy WebLinkAbout120 W Olive St - Affidavits/Owner Agent - 11/02/2017City
Flirt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 2.24-613
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) �U } Y� h n t'� ram. r--\ as owner of record (property
address)-1 W . Q 1 jy L ��, i� ^ known as (name of
business) ,'I V�e— hereby authorize the
work fisted below to be done on said property. I understand that such work will only be
performed contractors licensed by the City of Fort Collins.
AI 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 :
(Property owners nature)
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(Proper.y owner frame, please print)
The foregoing affidavit was acknowledged before me on the � r-4 day of
(month, year) by 1,1 n 86 AiGYypv�
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires: 14�(�';V'C�o
Permit B 17 0 416
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Notary Public
State Of '".OIo(ado
Notary lD # 20134046535
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