HomeMy WebLinkAbout4700 Lady Moon Dr - Affidavits/Owner Authorization - 12/21/2018Fort of
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) Katherine
owner of record (property
address) 4700 Lady Moon Dr, Fort Collins, CO 80528 known as (name of
business) Banner Health
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.
M I am giving permission for interior work only. The scope of the work shall be
limited to: Second floor patient wing
❑ 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 owner signature)
—
Katherine Dalby
(Property owner name; please print)
Slt"
The foregoing affidavit was acknowledged before me on the1 day off 1 L
eC-2XYV�W 2_01 p (month, year) by Gii �eJ' l C1 l Jam` �)L1
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires: g f ;L L / a l
111813899
Permit
Office use only
Notary Public
TARENA RAE ENGEL
Notary Publie • State of Colorado
Notary ID 2013402423
My Commission. Expires Feb 27, 2021