HomeMy WebLinkAboutN R ADD - INVOICE - 8/4/2010- � City ofAtins:
Planning, Development & Transportation
Engineering Department
PO Box 580 281 N"College Ave
Fort Collins, CO 80524
970-221-6605 P 970-224-6134 F
,Revocable Encroachment Permit for
Newspaper in the Right-cif-My
(minimum,of 5 business days+requiredIor approval)
Applicant Name:..s /` V ✓ BA'A41
►`w Phone:
Company: /`�� / J"
Address:
City, State, Zip: Cx/535�
Dates of Encroachment: 1 year from applicatiom approval
Locatiomof Encroachment; 0-1P RAS ° GUS D lrt
Contact Name :v r Wit) dt� Contact Email:
Applicant agrees to submit. with this permit application a sketch,drawing. or plan that iliustrates4he
location of the proposed outdoor eating area in the ipublicright=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 non -transferable, is personal to the Applicant and'is non:assignable. Applicant agrees that any
transfer of ownership of the business holdingtheipermit will: terminate-this,permit-and require a new applicationdo
befiled by the new owner.
Applicant has•read'this permit and agrees, toabide'bythe current' City of!Fort Collins Standard Specifications and to
any such special conditio strictions andl,reguiations that maybe imposed' by the City Engineer:.
Applicants Signature: Dater (�%'1/4
Engineering Appr(val: .tjns�LAZJ
m�
Application�Fee:, $
Conditions:
Revised,03/15/2016
Date?
Total Due: $ OZ Q ` co
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PermitNumber: