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 Owner � �/ Name In.,7 kt hl?
Date Title
STATE OF01 bg d )
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COUNTY OF I.An iA l r )
e foreg ing was acknowledgaj,befbre me thisday of ,+ 20 by
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_ My Commission Expires: 0,7
Notary Public
MELMORN.5 NCU
NOTARY PUBLIC
STATE OF COLORADO
NOTARY 10 2005402Q?3
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