HomeMy WebLinkAbout4700 BOARDWALK DR - AFFIDAVITS - 3/22/20120:6 niiigz
Citj/ OE
Planning, Development & Transportation
Fort ollins 281 N. College Ave
Fort Collins, CO 80s24
Phone 970-416-2740 Fax 224-6134
BUILDING OWNER AUTHORIZATION TO OBTAIN A COMMERCIAL
BUILDING PERMIT
%01A
I, (Print) Act,*
as owner of record (property
address) 4700 Boardwalk Drive For Collins known as (name of
business) Sam ' s Club #6633 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.
0 I am giving permission for interior work only. The scope of the work shall be
limited to:
13 I am giving permission for exterior work only. The scope of the work shall be
limited to:
�i I am giving permission for interior and exterior work. The scope of the work shall
limited to: interior remodeling, new exterior penetrations and
as hal re-seali
i' owners/gnatvre)
—Aq—]P�w /o A vesai
(Properly owner name; please print
'rtT
The foregoing affidavit was acknowledged before me on the o� Allt .' day of
"12A0 1- '22 7 &S (month, year) by -` �Cfd D ER. S 0 N
for the purpose therein set forth.
Witness my hand and official seal.
My Commission expires: " ' " -Ir 1 0,0 / y
s . -
Notary Public
Permit #
019Sce use only