HomeMy WebLinkAbout605 S COLLEGE AVE - AFFIDAVITS - 2/24/2017City of
Flirt 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) Dr. Richard Pass
owner of record (property
address) 605 S. College Ave Fort Collins CO 80524 known as (name of
business) 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.
B I am giving permission for interior work only. The scope of the work shall be
limited to: Interior demolition & remodel for new dental office
❑ 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 pant)
The foregoing affidavit was acknowledged before me on the Z�f+— day of
FebYV4V!j , 26) /-7 (month, year) by i(',AAy/( pi� 5 S
for the purposeltherein set forth.
Witness my hand and official seal.
My Commission expires: Feb( a-%v n ZyF; zvZo
Permit # 261(v40o 7S(,3
Office use only
B1700921
CAITLIN BRENNAN
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID 20164007563
MY COMMISSION EXPIRES FEBRUARY 24, 2020