HomeMy WebLinkAboutRIVERSIDE COMMERCIAL PUD SECOND - Filed MA-MINOR AMENDMENT - 2015-02-19City Of N'CC'_h
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Minor Amendment Application Form - ZoningDepartment
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Date Submitted: `1 • � S-/��
Project Name: Touchstone Health Partners Community Clinic
Project Location (Street Address): 1217 Riverside Ave. Fort Collins, CO 80524
Legal Description: Lot 4 and 4A, Riverside Commercial Planned Unit Development, Second Filing, City of Fort Collins, County of Larir
General Information: List all property owners having a legallequitable interest in the property (Attach separate sheets ifnecessary).
wner's Name (s .- Touchstone Health Partners
Street Address: 125 Crestridge St
Telephone:
Crty/State/Yip.- Fort Contns, CO 80525
970-494-4200 970-377-0967
Fax:
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Street Address: J2.3 Al. COLG�G� AVE: '54M4TOCity/State/Zip: -ro,,f
Telephone: fi'-20)�y6 $$ 29 Fax; �7(, Ems;
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_SUBMITTAL REOUIREMENTS-
1) Eight (8) 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
Cl IANGES ON the eight plans or provide eight copies of revised drawings showing the changes in addition to the
eight originals. ALI, PLANS MUST BE FOLDED TO 81/2" X 11 ";
2) Completed and signed Minor Amendment application form and Transportation Development Review Fee
application form.
3) Application fee of $350 ($192.00 Minor Amendment Fee plus $158 Transportation Development Review Fee).
Note: an additional $250 fee is required if the Poudre Fire Authority needs to review the application.
MINOR AMENDMENT.
Detailed description of the change and reason(s) for the request: /.5-7 C SCO �T _A pbl-f/o" To
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CERTIFICATION
I certify the information and exhibits submitted are true and correct to the best of my knowledge and that in filing this application, I am -acting with
the knowledge, consent, and authority of the owners of the property (including all owners having a legal or equitable interest in the real property, as
defined in Section 1-2 of the City Code, which is the subject of this application) without whose consent and authority the requested action should not
lawfully be accomplished. Pursuant to said authority, I hereby permit City officials to enter upon the property for the purpose of inspection, and if
necessary, for posting a public notice on the property.
Name (please PRINT): t)A Wv Ax o ES k y
Address: ►Z3 A/. Coll t-&E AVE Solt 3 D -T COL�i vS
Telephone:_ raj 7b /6 ^ 1"3$ Z `( Signature: _
9-2_4-14
281 N. College Ave, PO Box 580, Fort Collins, CO 80522, (970) 416-2745 F: (970) 224-6134