HomeMy WebLinkAbout424 PINE ST - AFFIDAVITS - 2/9/2012Fort 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
I, (Print) C G, nc-ek./1 77) 1 hC-Afe4- Z as owner of record (property
fr��stozz� -� cLa
address) known as (name of
business)
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.
�Y,I am giving permission for interior work only. The scope of the work shall be
limited to: i e� (AOV2 G (C'n U G.I' of 665r -C�ck-1 e:
)hdid rvwn((/i TIA,'-nI(li-)�ri-.��Gr,D��i�ft'r,a'\ ; ln57r.U&5zVJ
❑ 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 :
'(Properry ner signature) (Property owner name; please print)
1c�5%G�c of7'f �k'G
The ,f-orreegoing affidavit was acknowledged before me on thei 9 day of
(month, year) by G-nr�lan% �hr j,4au
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires:
B1200746
Permit #
Office use only