HomeMy WebLinkAbout903 BUCKINGHAM ST - AFFIDAVITS - 2/9/2009i'
Community Planning and Environmental Services
Fort Collins Neighborhood & Building Services
City of Fort Coll is 281 N. College Ave., P.O. Box 580; Fort Collins, CO 80522-0580; Voice: 970 2216760 FAX: 970 224 6134
OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) K-EN T 7.• �A tZ\j A as owner of record (property
Address) qG3 [O CKI K64+04-M, f�r27t- C�pU ( known as (name of
business) 4 'Tc'I NV �TMCNT-*, Nc, hereby authorize the work
listed below to be done on said property. I understand that such work will be
performed only by contractors licensed by the City of Fort Collins.
❑ I am giving permission for interior work only. The scope of the work shall be limited
❑ I am giving permission for exterior work only. The scope of the work shall be limited
to
W( I am giving permission for interior and exterior work. The scope of the work shall be
limited to
(Pr pe o er ignature)
The foregoing affidavit was acknowledged before me on the 7 day of
3P-tA R-q , Z6019 (month,year) by k<r--Wl- 7, C A-r2Nili\.[
for the purpose therin set forth.
Witness my hand and official seal.
My commission expires:
Permit #
(office use only)
W oEON OWIdM