HomeMy WebLinkAbout2121 Midpoint Dr - Affidavits/Owner Authorization - 09/12/2018Fort Collins
Planning, Development & Transportation
281 N. College Ave
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+6134
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) 7V'GVrf /-% ` "r as owner of record (property
address) 2121 Midpoint Dr., Suite 101 known as (name of
business) NeX.G« R;v�6. 4 Hyl d;!4s, t-1-c 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.
X I am giving permission for interior work only. The scope of the work shall be
limited to: Alterations to interior partitions, mechanical. electrical, and plumbing of the
existing office suite
❑ 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 :
(Property owner signature)
'�V1j 1i12 c-A its I
(Props /rty4owner name, pleases print)
The foregoing affidavit was acknowledged before me on the � 0C day of
�kanx o�0 (month, year) by T0..1 t S Nlr ie�
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires:
Permit # 3f� I
Office use only
tary Public
LAUREN L LANNING
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID # 20154011651
MY COMMISSION EXPIRES MARCH 23 2019