HomeMy WebLinkAboutN R ADD - APPLICATIONS - 11/26/2009 (11)R nni . Deveio, ment�& Trans ortation
Clty:of lip �� _ .
�'Q�• �O �S Eng neeripg;Department
( evocable Perm'It for � Permit Number SIR._,
Newspaperin, the !Ri'ght--&-Way Approval;Date:
(minimum of 7 daytrequired for approval)
Applicant Name:1-Jd 'Phone:
Company: 1 —
Address: %- 1; -±2M9 -
Clty, state, zip: -
Dates of Encroachment: 1,year from application approval
Iocatiomof Encroachment: CAM - 12' Qt 70it/J41)
Type: D1 Pay `Free );Newsrack
Applicant agrees to submit with this permit applicatlon a,sketch, drawing, or plan that
illustratewthe location of the, proposed newsrack,obstruction(s), or -other structure In the
public, rightof-way.
This permit is non -transferable;. le,personal to the,Applicent.and Is non -assignable:. Appllant
aggrees that any transfer of ownership ofthe business holding the permitwlll,terminate this, permit .
and require a. new,application tolbe•,filed"bythe. new owner:
Applicant has read'this permit and agrees to abide! by the current City of Fort Collins Standard
Speeiflcatlons and to any", s ch!special:co , res r , and regulations that maybe Jm-
posed by the,Cfty Engin r.
Appllcant's-Sign re: .� Date: ,
,7
Bngineering'Appr a : Date:
Application Fee: $ Total:Due: $ .: v.
OD
Conditions:
0
Lost Revised'7108
281' North College Avenue,SPA; Box 580.EFort Collins, CO 80622.0680 W0;221:6805 FAX 970221.6378-
www:fcgov.com/engineedhg