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HomeMy WebLinkAboutN R ADD - APPLICATIONS - 9/17/2010City of 'Fort Collins Planning, Development $ Transportation Engineering Department PO Box 580 ` 281 N College Ave FortCollins, CO 80524 970-221-6605 P 970-224-6134'F Revocable Encroachment'Permit for Newspaper:in,'the Right -of -Way (minimum of Sbusiness days required for approval) Applicant Name: ��h Phone: —A 0 'Company:�- Address: s?O %"L City, State, Zip: —O� i�. , Q g 0 z2a Dates of Encroachment: 1 year from application approval ;Location of Encroachment: Aa a A Q 'Contact Name: Contact'Emall: �oa-so Qi c��v��v�cxv.� t�SoCp►1 Applicant,agrees to submit,with this permit.application a sketch, drawing or plan that illustrates the location of 'the proposed outdoor eating, area in the public. right-of-way. Applicant must also submit the Indemnity. Agreement and a copy of the Certificate of Insurancewith the City of Fort Collins Engineering, Dept as Additional Insured. . This ;permit is non -transferable, is personal, to the Applicant and'is non -assignable. Applicant agrees that any transfer of ownership of the business holding the permit will terminate this.permit and require a new application to be filed, by the new owner. Applicant, hasread this permit and agrees,to abide by the current City. of,Fort Collins Standard Specifications and to any such special conditions, restrictions and regulations that maybe imposed'by the City Engineer. Applicants Signature: 'Date: t is Engineering Application Fee: $ / ©- 0 6, Conditions: Revised 03/15/2010 o Tota[,Due: $ / n-• d Permit Number:_ C! 000, Q 03 ]RA(