HomeMy WebLinkAbout5185 CARLSBAD BLVD; ; RW000186; PermitThe same name must appear on-this plicâtioi
refund as the Permittee. \
CITY USE ØN'.
APPLICATION. RECEIVED
CITY OF CARLSBAD - ENGINEERING DEPARTMENT
APPLICATION
RIGHT-OF-WAY PERMIT APPLICATION
JOBADDRESS
NEAREST CROSS STREET
ASSOCIATED PROJECT NO ASSESSOR PARCEL NO(S)
DRAWING NO. (if applicable):
BRlEF.DESCRlPTlON OF WORK: i!f,-W •-,
PROPOSED START DATE Lf - 2 aO1 STIMATED COMPLETION DATE
CONTRACTOR (Permittee)
NAME (Print or Type): ,4 V 1
. CONTACT PERSON: ./1t'Z" .
MAILING ADDRESS If '& 5ecf /2- V' 5-
PHONE NUMBER: 70 721/
24 HOUR EMERGENCY TELEPHONE
- STATE CONTRACTOR'S LICENSE NUMBER: L-/
STATE CONTRACTOR'S LICENSE TYPE: )
CITY OF CARLSBAD BUSINESS LICENSE NUMBER (2flhi g//I 11L i9-
By its signature below,\
City
agrees to indemnify, hold harmless, and defend th City of Calsbad or
its officers or employeé claims, damage or liability to persons or property arising from or caused
by an activity or work d uant to this permit unless the damage or liability was caused by the sole
active negligence of th tsgfflcersoremployees. This agreement is a-condition of the issuance
of a right-of-way permi j¼
rA
H:\WORD\DOCS\MISFORMS\Right-of-WayPerrnit Application) Rev. 11/15/96