HomeMy WebLinkAbout222 Laporte Ave - Affidavits/Owner Authorization - 08/08/2019City of
Fort Collins
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) 13 Ai Ant H F2&gTT as owner of record (property
address) 3oo L a O o r 6- A%fe. known as (name of
business) C o f1- F33/L'T Lei A)S 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.
V I am giving permission for interior work only. The scope of the work shall be
limited to:
Se-joe,ro-6 W os t 1 ,4 ckfe-c� 6r l..11Nw%Lr COn. c^fir.`$
❑ I am giving permission for exterior work only. The scope of the work shall be c
limited
❑ I am giving permission for interior and exterior work. The scope of the work shall
limited to :
&V'(#4i'j t±1LW-(0 o
(Property owner name; please print)
The foregoing affidavit was acknowledged before me on the '' -day of
Z01 / (month, year) by /'fX k
for the p ose therein set forth.
Witness my hand and official seal.
My Commission expires: �Ab . 7/ 2.022-
Permit #
Office use only
KAYLA D BALLARD
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID 20024003865
MY COMMISSION EXPIRES FEBRUARY 04, 2022