HomeMy WebLinkAboutPD 433; GOLF COURSE END OF HAYMAR DRIVE; Engineering ApplicationCITY OF ceLSBAD -ENGINEERING D.RTMENT
APPLICATION .
RIGHT-OF-WAY PERMIT APPLICATION
JOB ADDRESS: c;;o/r (J"e£4f ,e--,ifJ) at !I,If'/ffl1f1A= /J~/<Jt
NEAREST CROSS STREET E'-t:?A-dt(,/Yu ~tfiT tt/
ASSOCIATED PROJECT NO . .pDY~ ASSESSOR PARCEL NO(S) _-----, ______ _
DRAWING NO. (if applicable)._~~7"",,"-..;;;;5 ____ _
BRIEF DESCRIPTION OF WORK: e for4'" 0 f.f' dA'I/!tA'lf!. &Ie &,4/Jl'ievd ~,vI
"PROPOSED START DATE:' tf / If ESTIMATED COMPL.ETION DATE:
CONTRACTOR (permittee)
NAME (Print or Type) RDEe~k Wt7tm(JthHG
CONTACT PERSON: ()/ c.fTJ Il i?t5 B e ~ +-$
MAILING ADDRESS: /II 0 .~. Esc 0 ,.u:.liJ Cl ilL U I E s(6l1.fdilo.
PHONE NUMBER: 7 C-( b .... j q 3 L
24 HOUR EMERGENCY TELEPHONE:---;.1....L1'-I.r_-__ 7:...;./~~ __ 7:...__· ________________ _
STATE CONTRACTOR'S LICENSE NUMBER:_I+:...:-· -~tt~f ...... 3:.-~CJ&...L/_C,---_________ _
STATE CONTRACTOR LICENSE TYPE: G e/Vefl.JH. £PJfv('e..e./~~ cc,,/, t-. . . ..."
CITY OF CAAtSBAD BUSINESS LICENSE NUMB.ER: 1/ C( g g b L{
By its signature below, per.mittee agrees to indemnify, hold harmless, and defend the City of Carlsbad or
its officers or empleyees from aI/ qlaims, damage or liability to persons or property arising from or
caused by an activity or work done pursuant to this permit unless th' damagta or liability was caused by
the sol ctive negligence of the City or its officers or employees. This agreemeht is a condition of the
of a rig.h1jf-w~.er '. .
1CttA7b . •• ,or/; 2-/ qLj =SI~G~N~AT=U=R~~~---~---------~---DA1E
The same name must appear of this application, the Cash Security Agreement and request for refund as
the Permittee. .
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P:\DOCS\MISFORMS\FRMOOO58 REV. 04/06/93