HomeMy WebLinkAboutN R ADD - APPLICATIONS - 10/11/2010 (12)r.. _...,
MY of
Fort Collins
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: 1&riV% Phone: f ZO— 2.-bR— $a35
Company: Rp�&ATur Sou Nce
Address: t STG 31'k" !&uLpeR CO b03G 7-
City, State, Zip:
Dates of'Encroachmerit: 1 year from application -approval
Location of Encroachment:
V OF
Contact Name: Contact Email: (=TMA.A. 9,col-VR Q 6MA4L. c c&,
Applicant agrees to submit with this permit application a sketch, drawing orplan .that illustrates the
-location of the iproposed outdoor eating, area in the public right -of way. Applicant must also submit the
Indemnity Agreement and a, copy of the Certificate of Insurance with the,City of"Fort Collins Engineering
Dept. as Additional Insured.
This permit is non4mnsferable, is personal to the Applicant and is non -assignable. Applicant.agreeslthat any -
'transfer of ownership of the�business holding the permit will terminate this perrnit.and require anew application to
be filed by the new -owner.
Applicantbas read.this permit and>agrees to abide by the current Cityof Fort Collins Standard. Specifications and to
any such special conditions, restrictions and ,regulations that may be Imposed bythe City Engineer.
Applicants Signature: Date: to [ D
Application'Fee::$
Conditions:
Revised 03/15/2010
:Date:
Total Due:-$ Z0 ,
Permit Number: �L C�rO �✓N w