HomeMy WebLinkAbout4609 S Timberline Rd - Affidavits/Owner Authorization - 09/23/2016Planning, 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) �E'�t k't'� vU `x as owner of record (property
address) Tl7d� I iY�e/ �(v� known as (name of
business) u—('`�`� Gam— `'�� 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:
It
C'I( J-%.1f kod(t"-5'
❑ 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 :
owner
4r4�'
(Property owner name; please print)
The foregoing affidavit was acknowledged before m,e-�/onn the 2 nLe.3 day of
`(j YYl aO1 (month, year) bye iCfit .�T�, n yIy�i5seu
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires: (Sfi 2019
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Notary Public
Permit - MAE MCCARTNEY
office use only KAYLA
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID 20154034780
MY COPNlISSION EXPIRES SEPTE,.IBER 1, 2019