HomeMy WebLinkAbout4501 S LEMAY AVE - AFFIDAVITS - 11/14/2011City of
Fart 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) A k,(-ze'k, as owner of record (property
address) L%SO l S • L to A 00- • known as (name of
business) D fLt- C-/'—' `ay ��,z-, 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.
❑ 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 to:
❑ I am giving permission for interior and exterior work. The scope of the work shall
limited to :
(Property owner signature)
(Property owner name, please print)
The foregoing affidavit was acknowledged before me on the Y-1'-� b�-- day of
r� k l.) 'aO i (month, year) by 4--� y�it y ,< to( t to
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires: (�^ 1I- c
Notary Public
Permit # 0
OfFce use only
CHRIS
i-- HAFE4