HomeMy WebLinkAboutN R ADD - APPLICATIONS - 10/11/2010 (10)C#t O Planning, Development & Transportation
yf Engineering Department
Fort Collins PO.Box 580 281,N College Ave
Fort Collins, CO 80524
970-221-6605 P 97042"l34 F
Revocable Encroachment Permit for
Newspaper `in the 'Right -of -Way
(minim== b business days required for approval)
Applicant Name: S <UML Phone: -+ZO— 24l°I— $0,35
Company; PREM1~uM Sou P ILE T-V,�
Address: t IG Q ec ri Sout_pese CsJ b03c, Z
City,, State, Zip:
Dates of Encroachment: 1 year from application approval
Location. of Encroachment:. Mot n Aon A- U-Mm r-hf & To lit
Contact Name: Contact Email:rHRI. �uvSitR CSl CZMA.1:l . cc M
Applicant agrees to submit with this 'permit application a sketch, drawing or 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 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 holding. the permit will terminate this,permit and require a. new application to
be filed 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: td 1 1 [ 0
Application'Fee: $ f D'
Conditions:
Revised 03/15/2010,
Date: rDr—//,
--�
Total Due: $ %p ^ COC'
Permit Number• ��� 0 INN Lj