HomeMy WebLinkAbout155 Fairway Ln - Affidavits/Owner Authorization - 11/09/2017City Of Planning, Development & Transportation
Flirt Collins 281 N. College Ave
""'ins, CO 80524
1 Phone 970-416-2740 Fax 224-6134
7 0 7 [ 9 3
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) J Ernest Brown as owner of record (property
address) 155 Fairway Lane, Fort Collins, CO known as (name of
business) N/A 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:
M I am giving permission for interior and exterior work. The scope of the work shall
limited to :
1
J. Ernest Brown
(Property owner name, please pnnt)
The foregoing affidavit was acknowledged before me on the � day of
/'%VEM6t-> ) 20 1-7 (month, year) by _ J t✓ ?.d ETT I✓3 P--,:> wAJ
for the purpose therein set forth. , 11
Witness my hand and official seal.
My Commission expires:
-f-23.20 20
Permit #
Office use on/y
HOLLYAT=
NOTARY PUBLIC
STALE OF COLORADO
NOTARY ID 201240DIA
OOMM16SION EXPIRE91(i?9i
Pub/ic