HomeMy WebLinkAboutN R ADD - APPLICATIONS - 10/11/2010 (3)City of
F�o�rt Collins
Planning, Development & Tram ft?5 2011 AM S:59
Engineering Department
Mlilox:580 281, N College Ave
Fort Collins, CO 80524
9M221-6605 P-970424-6134 F
Revocable Encroachment Permit for
Newspaper in the 'Right -of -Way
(minimum of 5 business.days required forapproval)
Applicant. Name: _ � h Y+ �t� .r Phone: �'2'0 _ g63
Company: PIGr th �. a ; ✓�
Address: _ fo 5`
'City, State, Zip:,- 50 UVzr CO ftNox
Bp IA)- 91'2¢,L*
Dates of Encroachment: 1 year from application approval 4, �c3
Location of Encroachment: ce ; �y 'Po,,r r
Contact Name �a +, �7Vp,r Contact`Email: G ka.,, f•,S '.®. �n.c� �,.c�Y►,
Applicant agrees,to submitwith,this,permit application a sketch, drawing, orplamthat,lllustrates the
location of the p5oposed outdoor eating area Inthe public right-of-way. Applicant -must also submit the
Indemnity Agreement anda, copy of theZertificate of Insurance with the City of Fort Collins Engineering
Dept as Additional Insured.
This permit lemon -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 flied by 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 by the City Engineer.
Applicants Signature:
Date:
Engineering Approv Dater. /�� 0
eau Application Fee: $ / U ' Total, Due: $ Z O ' ®Q
Conditions:
Permit Number:
Revised,03/15/2010