HomeMy WebLinkAboutN R ADD - APPLICATIONS - 10/11/2010 (4)JAN 25 2011 AMS:59
City, of
F�ort Gottins
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 -of -Way
(minimum of 5 business days required for approval)
Applicant,Name: M,r Phone: W'O- )-'M bols""
Company. ov �ef J , `a:a": ; --k
Address: io3 S` pet-45'1 31 j
City, State, Zip; F20 UWAr' t C 7 �D Doi
Dates of Encroachment: 1, year from application,approval
Location of Encroachment a.13 F 1 1 z.;, �^ - � - I, u T�+v�r•�.
Contact Name: L+I anContact'Email: 6 �ke"". 'i'� ® ��►��., �, �h,
Applicant agrees to submit with this permit application a sketch, drawing orplan thatslllustrates the
location of the ,prpposed outdoor eating area in they public right-of-way. Applicant must also submit the
Indemnity Agreement and a copy of. the Certlficate of Insurance with -the -City of Fort Collins, Engineering
,Dept as Additional Insured.
This permit is nontransferable; is personal to4he Applicant and is non -assignable. Applicant agrees that any
transfer of�ownership of the business holding the permit will terminate this permitand �require a new application to
be filed by the new owner.
Applicant has read this permit and agrees -to abide'by the current City offort Collins Standard, Specifications: and to
any such special conditions, restrictions andiregulations that may be imposed by the City Engineer.
Applicants Signature: Date: C>
Engineering Appro al Dater 1p
Application Fee: $ / tq ' dv Total Due:
Permit Number: no.
Revised 03N5/2010