HomeMy WebLinkAboutN R ADD - APPLICATIONS - 7/16/2010 (4)i
City Of Planning; Development & Transportation
� /}�/� Engineering Department
• V� �f. C�lliitS. PO Box 580 281 N;College Ave .
'Fort Collins, CO 80524 i
970-221-6605 P 970-224-6134!17
Revocable Encroachment Permit for
Newspaper in the '.Right -of -Way
(minimum of 5ibusiness dayssequired for approval)
Applicant,Name: -� `it�Pt# S Phone976-0I9-�;�j�
Company: DCl/�4 <oty �Ia�
Address: �� � % uiR �i air
.City, State, Zip: jzca.1nk_1,
!Dates of Encroachment: 1 year from application, approval
Location of Encroachment:�;ti
Contact Name: f��Contact Email ka11\+4,N1J+j� - rn
Applicant agrees to submit with this permit application a sketch, drawing .orplan that illustrates.the
location of the proposed outdoor 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 Additional Insured. .
This permit Is nonAransf®rable, ls;personal.to the Applicant and is non -assignable. Applicant agrees thatany,
transfer of ownership of thelbusiness holding the. permit will, terminate thispermit,and•require a new application to
be filed Eby the new 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 bythe City Engineer.
Applicants Signature: Date:Alell10
•
Engineering. Approval:
Application Fee: $
Conditions:
Revised o3/15/2010
.Date:
Total. Due:
PermitiNumber: