HomeMy WebLinkAbout1800 E Prospect Rd - Affidavits/Owner Authorization - 01/29/2018Fort 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
owner of record (property
:nown as (name of
business) [ tTePAZII _"bD J UI MD►I Q'Y" C01 W0hereby 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
I am giving permission for interior and exterior work. The scope of the work shall
/ limited to : (RkYfo✓ bU0✓V-- = Y-q a(X i, / (r &N b1OC'L wCV1d6ws &K or W-+�-�A 64 w
�'t'Ur�� Vvl �v�s. ,}e�io✓ wu� .- rc-SicLi wuN' i'j' 'k;
1 LA-1 U (7iiC�(
J� Ytv` Y�Q 5�a.1.t ",\J AkA- r a-" OIL GM-r ,1
C16 1 t1.4c o&vd 1,vesisaW-
erty o ne(signature) (Property wn rname, please print)
The foregoing affidavit was acknowledged before me on the 1 1_ �d1ay of
Y (month, year) by KP�_sL�� 1
For the purpo erein set forth.
Witness my hand and official seal.
My Commission expires: 2/2/Z0(Pj
Permit=# 1 9 0 0 6 6 3
Office use only
ELISA THORNTON
NOTARY PUBLIC • STATE OF COLORADO
Notary Identification #20154005670
My Commission Expires 2/2/2019
Notary Public