HomeMy WebLinkAboutN R ADD - APPLICATIONS - 10/11/2010 (8)city of
Fort Gothns
Planning,, Development & Transportation
Engineering Department
PO Box 580 28I N College Ave
Fort Collins, CO 80524
970-221-6605 P 970-224-6134 F
Revocable Encroachrnent'Permit for
Newspaper in the Right -of -Way
(minimum of 5 business days required for approval)
Applicant Name: Phone: _1ZdIM S9
Company: S!(Z;EM-rur Sou P.(.E . 2v.c_
Address: t 3S Q -A . 51 \ BIDUc peR C-0 b03r Z
City, State,, Zip:.
Dates of Encroachment: 1 ,year from application approval.
Location of,Encroachment:
Contact Name: E� '� tfLAft Contact Email: E*rNAril..��wci�R C�I�MA t_.Lc
Applicantagress to submit with this permit application a sketch, drawingior plan that.illustrates 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
transferof ownership of the.businessfiolding the permit will terminate this, permit and requiie:a new application to,
be filed by the new owner.
Applicant has, read this permitand agrees to abide by the current'City offbrtCollins Standard Specifications,and to
any such special conditions, restrictions and regulations that may be imposed by the City Engineer.
Applicants Signature: Date: �(� l [ D
Date: /Oz/r ho
Application''ee: $ D " Total Due: $p • �'"
Conditions:
Permit Number: 9 10000 U I"t" P
RevisediO3/16/2010