HomeMy WebLinkAbout4501 S LEMAY AVE - AFFIDAVITS - 6/1/2011City/
" of Planning, Development & Transportabon
FortCollins
281 N. College Ave
Fort Collins, CO 80524.
Phone 06416-2740 Fax 224-6134
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL,
BUILDING PERMIT
Ii(Print)-- as owner of record (property
address)— -,known as (name of
business) hereby authorize the
work listed below to be done on said property. I understand thatsuchwork will only be,
performed contractors licensed by the City of. Fort Collins.
0 1 am giving permission for Interior work only, The scope ,of the work shall be
limited to:
0 1 am giving permission for exterior work only. The scope of the work shall be
limited to:
�j arngiving permission for interior and exterior work. The scope of the Work Shall
limited to
Viet
(PMPefty owner signature) (Aj?pajy owner name; please print)
The foregoing affidavit was acknowledged before me on the day of
-ZCW (month, year) by dd I-e—
for the -purpose therein set forth.
Witness my hand and official seal.
My Commission expires: C)5 -I i- 10 P
Permit
Office use only
81102,s.n