HomeMy WebLinkAboutN R ADD - APPLICATIONS - 9/17/2010 (6)City of
/Fort Collins
Planning, Development &Transportation
Engineering. Department
PO Box 580 ' 281 'N College Ave
Fort Collins; CO 80524
970-221-6606 P 970-22"134 F
Revocable Encroachment Permit for
Newspaper in the Right -of -Way
(minimum of 5 business days required for approvel)
Applicant. Name: V0•h ek Phone: -x to — ax.�_,"r'I' � Q
Company: �w� u.r_ a.
Address: --szo
City, State, Zip: `-�0� d w , �ii sos7m
Dates of Encroachment: 1 ,year.from application approval
Location of Encroachment:..
Contact Name: �--=a��-A-�� r Contact'Email: `vim Q 0+1 c��u��.vv�d-�a.bot�S,Cp1'1
Applicant agrees to submit with this permit application a sketch, drawing or plan that tliustrates.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 Insurance with the City of Fort Collins Engineering
Dept as Addidonal Insured.
This permit Is non -transferable, ;is personal to the Applicant and is non -assignable. Applicant agrees that any
transfer of ownership ofthe business holding the permit will terminate this permit and require:a new application to .
be filed by the new owner.
Applicant has read this permit and agrees to abide by the,current City of Fot Collins Standard Specifications and to
any such special conditions, restrictions and regulations that may be imposed'by the City Engineer..- _ --
Applicants Signature: Date:
Engineering
ApplicationFee:
Conditions:
Revised 03/15/2010
Date: 9 - ,17 -/ T)
Total Due: $
Permifi;Number: