HomeMy WebLinkAbout5220 SOUTHERN CROSS RD - 2ND POD - Filed P-PERMITS -City of ,ktColll� Planning, Development & Transportation
Engineering Department 281 North College AvenueP.O. Box580 Fort Collln$, CO 80522.0580
970.221.8605 970.221.6378 -fax kgov.oomhlngfnHring
REVOCABLE ENCROACHMENT PERMIT APPLICATION
in the Public Right-of-Way(Minimum of 5 business days required for approval)
ENCROACHMENT SUBMITTAL INFO: All submittals MUST include the following with this application: 1.A sketch plan that shows the proposed location(s) of the encroachment(s) and locations of the property 1ine(s),sidewalk(s), and street(s). A licensed surveyor may be required to accurately locate property boundary(s).2.Applicants for an encroachment permit that will occupy any parking spaces in the downtown area must notify the Cityof Fort Collins Parking Services Department, at215 N. Mason Street, (970) 221-6617.
Applicant Name: Trevor Ghylin Ph one: _41_�_-=-_2_1_7_-7_7_84 __ _
Company: ________________ Email: trevor.ghylin@gmail.com
Address: 7337 Portland Avenue City: Wauwatosa State: WI Zip: 53213
Sub-Contractor:,_.....,.. ____ ��---,-----------Phone: ---------
Address: ________________ __;Clty:, _______ State: __ Zip: __ _
Location of Encroachment (Address): 5 220 Southern Cross Lane, Fort Collins. WI 53213
TypeofRigh t-of-waylmpaded: • Street D Alley D Sidewalk D Other:-------
Purpose ofEncroachmen/�00S for moving (81x8'x161 long each)
Dates of Encroachment From: _ __,_/ _ _,___ 6/22/21 -6/26/21 To: _........__.,_/ __ or Until Revoked (permanent type items)
This pennlt Is non-transferable, la personal to the Applicant and la non-assignable. Applicant agrees that any transfer of ownership of the business holdlng the pennlt will tennlnate this pennlt and require a new appllcatlon to be filed by the new owner.
Appllc�anrn&-reacrth1e1>&rm1t·and agreeno allll:!ifbyltie Clty1>fFort co111ns""Mun1erparCOde1, StamianrPIDJ'is Aria :;:Specifications and to such special conditions, restrictions, and regulations as may be imposed by the Engineering Department.
T Gh I. Olgltaly signed by Trevor Ghytln 4/e/21 APPLICANT S1GNATURE:_re_v_o_r _ ___.;.Y_1_n ____ 0a_1e_: 2_02_1_.04_.06_19:_34_:0_3-05'_00' __ .DATE::f:; , 1�----------------------;tc>1 Encroachment PermltType: • Minor
Permit Fees: ApplicatiOn Fee: $_1_0 ___ _ D Major
Inspection Fee: $_1_0 ___ _
I ftAJ
Total Due: $2 0 ·-----
Conditi on s: ________________________________ _
c1TY oF FoRr coLL1Ns APPRov&J D L 1\\Qa tu. :14=_oAre: L./-\ � · a.. I
Revised: 10/15/2018 1 V PennltNumber: _________ _ 21-9024
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2 PODS containers {8'x8'x16' long each)
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,5220 Southern Cross Ln,
Fort Collins, CO 80528
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