HomeMy WebLinkAbout4609 S Timberline Rd - Affidavits/Owner Authorization - 09/23/2016 (2)Planning, Development & Transportation
281 N. College Ave
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
-"UILDING OWNER AUTHORIZATION
BUILDING
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1, (Print)--- Y! 1 �iii h 0 as owner of record (property
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address)�7 ? i�^'i� �iylz Pry known as (name of
business) 'i e d;fAlk"y a-1111'5I'v` Rey V; ,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.
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
❑ 1 am giving permission for interior and exterior work. The scope of the work shall
limited to
olvner
Fyn � jj
(Property ownernarne pfevse print)
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The foregoing
/affidavit wasacknowledgedbefore m�eyon/the
yV ( _ 3 day of/
SI,t 7 fit/ l t (month, year) by` -nr{�- y } ✓ IL-{.�'.N,`, i{.'�1�----
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires: 11s, 2011
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Oilire use only
Notary Ptjt�t,'c
KAYLA MAE[ACCARTNEY
NOTARY PUBLIC
STATE OF COLORADO
NIOTARt ID 2:, i5A0a4 b0
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