HomeMy WebLinkAboutPOUDRE VALLEY HOSPITAL - Filed MA-MINOR AMENDMENT - 2015-06-02„arof
t\ Collins
Comments Due By:
Minor Amendment
Planner
Effective Date
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Minor Amendment Application Form --Zoning Department
Date Submitted: (a
Project Name: r t (' Ar��GHS ov� PU #Wor Amendment Fee: $192
Project Location (Street Address): R064san Sf• �OC- Or S A A Transportation Development Review
AN-i
Legal Description: Ift I A in o• Fee: $250 (when applicable)
General Information: Lis�j11 pr perty ow er having aft,
wner's Names rC I&CUt �� ��{y t10!
Street Address: S. ke. oq Au C .
Telephone: n1o, Fax: In a
interest in the property (Attach separate sheets if necessary).
C ity/State/Zip: To (+ (. Ol 11 A
pplicant's/Consultant's Nam J er O d f JLkW a Name of firm: lJ HA S, VI h (-• Street Address: 1 %03 C) - JCA D:` • City/State/Zip: -Fdrt ��(� AS t a �� S GJ a
Telephone: q?d • aa3•f%5 l Fax: qOG. as3, 19 a Email:gn�p%IA�,�b�SVi,fOK
SUBMITTAL REQUIREMENTS:
1) Seven (7) copies of RECORDED plan (i.e. site, landscape, elevation, etc. - whichever is being altered) on 24” x
36" size (usually available at the Technical Services Department at 281 N. College) — RED -LINE THE
CHANGES ON the seven plans or provide seven copies of revised drawings showing the changes in addition to
the seven originals. ALL PLANS MUST BE FOLDED TO 81/2" X 11";
2) Completed and signed application form(s); and
3) Application fee of $192.00 (or $442 if Transportation Development Review Fee required).
4) Poudre Fire Authority (PFA) requires a separate Development Plan Review application and fee for minor
amendments which must be submitted directly to PFA. Information for their process can be found at
https://www.pfafireprevention.org/node/73
MINOR AMENDMENT
Detailed description of thechange and reasonlv\
or the request: rm tl -el4l rL4. 0, !b4 rf .Yr4
r0t1Y_ �o a A,*ireADv a�„r�
CERTIFICATION
I certify the information and exhibits submitted are true and correct to the best of my knowledge and that in filing this application, I am acting with
the knowledge, consent, and authority of the owners of the property (including all owners having a legal or equitable interest in the real property, as
defined in Section 1-2 of the City Code; which is the subject of this application) without whose consent and authority the requested action should not
lawfully be accomplished. Pursuant to said authority, I hereby permit City officials to enter upon the property for the purpose of inspection, and if
necessary, for posting a public notice on
the property.
Name (please PRINT): � LA_ UJ d-,
Address: d csF �r - J r; V
Telephone: - 1 �G , aa3 . r r 5 ' / Signature:
281 N. College Ave, PO Box 580, Fort Collins, CO 80522, (970) 416-2745 F: (970) 224-6134