HomeMy WebLinkAbout424 PINE ST - AFFIDAVITS - 11/13/2013Fort 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
I, (Print) ede
r_� as owner of record (property
address)n����i known as (name of
business) UM r +e Wct V rz_eL n(ercQtzf'� 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.
�1 I am giving permission for interior work only. The scope of the work shall be
limitedto: t'�i ✓lq t� i �q i�a t is �o r C(ci ssroan Cad
�2GtC�4 i
❑ I am giving permission
limited
V)l ee-t � '-((C e'
exterior work only. T
C 7` ' 01Ae� l�IcrX rI ZGc2 7dY15
Cod
:ope of the work shall be
❑ I am giving permission for interior and exterior work. The scope of the work shall
limited to :
(_Property opener name, please print)
The foregoing afffiidavviit was acknowledged before me on the I 3 day of
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires:
Permit #
Office use on/y