HomeMy WebLinkAbout1408 S Shields St - Affidavits/Owner Authorization - 10/28/2016City 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) Julie Birdsall as agent for CSURF as owner of record (property
address) 1400, 1408, 1410 and 1412 S Shields St. 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
13 I am giving permission for interior and exterior work. The scope of the work shall
limited to• Complete demolition of residential structures and foundations.
(Property own r signature) (Property owner name; please p ' t
t C
The foregoing affidavit was acknowledged before me on the o` day of
z�10/4 (month, year) by J,("P
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires: alia0aoao
.�0 4 A
Permit #
Office use only
� L1ifv
KATHI L. MCDONALD
NOTARY PUBLIC
STATE OF COLORADO
NOTARY I DO 20044005076
MY COMMISSION EXPIRES 02-12-2020