HomeMy WebLinkAbout947 WORTHINGTON CIR - AFFIDAVITS - 1/25/2010Community Planning and Environmental Services 000473
Fort Collins Neighborhood & Building Services
citvui F�rrcc,nins 281 N. College Ave., P.O. Box 580; Fort Collins, CO 80522-0580; Voice: 970 221 6760 FAX: 970 224 6134
OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
I, (Print) J R ��� c� r� W)\ ll S«Y\ as owner of record (property
Address ",y j�
- 5? �{ f /7/*'IG-' o/k (,12 • known as (name of
business) - ' / \ -5 rll 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 worjk only. The scope of t evv9r hall be limited
to E cl1h / u .t�¢ l;aS %/ a 4 �>^ Wex/-/s
QtR. � /21 t1 -Ofw-
❑J I am giving permission for exterior work only. The scope of the work shall be limited
to
❑ I am giving permission for interior and exterior work. The scope of the work shall be
limited to
t
The foregoing idavit was acknowledged before me on he a:5 day of
�Ar/ o`il7ty (month,year)by-Sbt16�"
for the pur ose therin set forth.
Witness my hand and official seal.
My commission expires: c?-1-aOlU
Permit #
(office use only)
PublicNotary �