HomeMy WebLinkAbout2831 TORRY CT; ; RW000194; PermitCITY OF CARLSBAD ENGINEERING DEPARTMENT
APPLICATION'
RIGHT-OF-WAY PERMIT APPLICATION
JOB ADDRESS TbZdZ.Y
NEAREST CROSS STREET
SSSÔCI AT' ED PROJECT NO (3 / '/7 9 ASSESSOR PARCEL NO(S)
DRAWING NO (if applicable) r
-
BRIEF DESCRIPTION OF WORK
•... I
I •# -
PROPOSED START DATE 2_0 -00 ESTIMATED COMPLETION DATE Zc) -oo
CONTRACTOR (Permittee)
•(
NAME (PrintoType): PO OL- A( 5P,.-..:. 7fZ.
CONTACT RERSON -ug4 (Tot7
MAILING'ADDRESS C9 c/oii -T
PHONE NUMBER:6117
24 HOUR EMERGENCY TELEPHONE
STATE CONTRACTOR'S LICENSE NUMBER: V 5 -.
STATE CONT\RACTOR S LICENSE TYPE
CITY OF CARLSBAD BUSINESS LICENSE NUMBER 272
By its signature below permittee agrees to indemnify hold harmless and defend the City of CrIsbad or
its officers or. employees from all claims, damage or liabiIit- topersons or property arising fràm or caused
Ly an-activity or work done pursuant to this permit unless the damage or liability ias.caused by the oIè
active negligehcé of the City or its officers or employees. This agreement is a condition of the: issuance
of a right-of-way permit
TRE DATE
The same name must appear on this application, the Uasn-ecurity Agreement ana tne request br.-
refund as-the Permittee. .IM
PR 182000 :
NGINEER,NG ••1
PARTM. •, -•
DATE, STAMP
A.
1tPAPPROVEDBY ' DATE 5k(0C
I _INSURANCECHECKED BY; EXP DATE O91Y1101
:- -. . • . .... .
H:\WORDDOCS\MISFORMS\Riht-Of-Way Permit Application)
it
IL
-' 4' •s)Ii
Rev. 11/15/96