HomeMy WebLinkAbout808 W PROSPECT RD - AFFIDAVITS - 7/11/2016City of Planning, Development & Transportation
F(5rt h 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) ,� L N �` eas owner of record (property
address)_` ® �? _. �?�� Ps�'m _ V-D known as (name of
business) _W"ik P2�ti;-r� 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 Port 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:
EYI am giving permission for interior and exterior work. The scope of the work shall
limited to :
owner
tv"aA00 -;'vsm tAf s1.Iea-5." jzeA4 G'X-.V,
kAq-"+�-Esa 1A _ P4Ze,%v1&.-r1�p CSO `vA
(Property owner name, please print)
The foregoing affidavit was acknowWged before me on the I Ith day of
b (month, year) by �4 tl,`441°PE-.Aen !r '"
for the Arpose ffierein set forth.
Witness my hand and official seal.
My Commission expires: of
Permit #
Ofte use only
_ C .
Notary Public
MARY RICHLING
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID 19914001246
KJY COMMISSION EXPIRES OCTOBER 29, 2010