HomeMy WebLinkAbout1 OLD TOWN SQ - AFFIDAVITS - 6/19/2013Fort of
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
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I, (Print) as owner of record (property
address) y known as (name of
business) P ,Ilik ( vl �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.
A 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 :
&W T S
(Property owner name; filease print)
The foregoing affi/it was acknowledged before me on the day offer 11//
moo) IA vi, % r l S (month, year) by Y 1 °I 1^ SC v1
for the purpose therein set forth.
Witness my hand and official seal. RACHELLE VASHTI BATJARGAL
Notary Public
My Commission expires: V? I z O) State of Colorado
in
Not ry Public
Permit #
Office use only .
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