2014-09-11_REVISION - M1979097

• Permit No: M1979097
• IBM Index Class Name: Revision
• Doc Date: 9/11/2014
• Doc Name: SO Application
• From: City of Fort Collins ‎(Utilities)‎
• To: DRMS
• Type & Sequence: SO5
• Email Name: ECS
• Email Name: TAK
• Media Type: D
• Archive: No

NOTARY FOR STRUCTURE OWNER
ACKNOWLEGED BY:
Structure khoS�ln KG;lwqy a�Co�arc��V CC
Name
Date i0 i Z,12-ow Title C.EQ
STATE OF )
)ss.
COUNTY OF )
Th� foregoing was acknowledged before me this day of OC66ec
K2s1i n Skulba- as CL.A Of6l a L+ &l0r4A0
My Commission Expires: /or/ �l�
Notary Pu lic rT
MARY I HILL
NOTARY PUQLIC
STATE OF COLORADO
NOTARY ID 20044030318
W COMWSSION E)MES NOVWM 1,2016