HomeMy WebLinkAboutN R ADD - APPLICATIONS - 9/17/2010 (3).Fort Collins_
Planning, Development & Transportation
Engineering Department -
PO Box 580 ` ' " '281 N College Ave
Fort Collins, CO 90524
970-221-6605 P 970-224-6134 F
Revocable; Encroachment Permit for
Newspaper in the Right -of -Way
(minimum"of'5 business days required4or,approval)
Applicant Name: �0.h Phone:(i — a�
Company: �Cn
Address:O
City; State, Zip:—O�c�.w,C�l
Dates of Encroachment: 1I year from application approval
Location of: Encroachment: 1,Ar- ,A
Contact Name Contact,Email: �0d'N4- a1 c�v�� inpta�n�-botS �cpf'�
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 submitthe
Indemnity Agreement.and a copy of the Certificate. of insurance with the City of Fort Collins Engineering
Dept as Additional Insured:
This permit 1s 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 bythe now. owner,
Applicant has read ,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 may be imposed by the City 'Engineer.
Applicants Signature: Date: 11C C2�C�
Engineering
Application Fee:
1' Conditions:
Revised 03/15/2010
Date: - l '7 - / a
O. , Total Due:. $ / O , CC
Permit Number: V C