HomeMy WebLinkAbout1981 HIGH RIDGE AVE; ; RW970260; PermitCITY OF CARLSBAD - ENGINEERING DEPARTMENT
APPLICATION
RIGHT-OF-WAY PERMIT APPLICATION
JOB ADDRESS .n. t+ -t 4A QE c,e 4ja
NEAREST CROSS STREET?
ASSOCIATED PROJECT NO.:
1OR PARCEL NO(S): L 0-7 -3-jjp_o
DRAWING NO. (if applicable):
BRIEF DESCRIPTION OF WORK:
PROPOSED START DATE:
ESTIMATED COMPLETION DATE:
CONTRACTOR (Permittee)
NAME (Print orTyp xQv ct&
CONTACT PER$O. .4-j -
MAILING ADDRESl L. dp,j , t.Ai
PHONE NUMBER: D '-t
24 HOUR EMERGENCY TELEPHONE: -. .. ..
STATE CONTRACTOR'S LICENSE NUMBER:
,r
STATE CONTRACTOR'S LICENSE TYPE:
CITY OF CARLSBAD BUSINESS LICENSE N
U
M
B
E
R
:
-
By its signature below, permittee agrees to indem
n
i
f
y
,
h
o
l
d
h
a
r
m
l
e
s
s
,
a
n
d
.
d
e
f
e
n
d
t
h
e
C
i
t
y
o
f
C
a
r
l
s
b
ad or
its officers or employees from all claims, damag
e
o
r
l
i
a
b
i
l
i
t
y
t
o
p
e
r
s
o
n
s
o
r
p
r
o
p
e
r
t
y
a
r
i
s
i
n
g
f
r
o
m
o
r
c
a
u
s
e
d
by an activity or work done pursuant to this per
m
i
t
u
n
l
e
s
s
t
h
e
d
a
m
a
g
e
o
r
l
i
a
b
i
l
i
t
y
w
a
s
c
a
u
s
e
d
b
y
t
h
e
s
o
l
e
active negligence of the City or its officers or
e
m
p
l
o
y
e
e
s
.
T
h
i
s
a
g
r
e
e
m
e
n
t
i
s
a condition of the issuance
of a right-of-way permit.
.
1611A71
SIGNATURE
DATE
The same name must appear on this applicatio
n
,
t
h
e
C
a
s
h
S
e
c
u
r
i
t
y
A
g
r
e
e
m
e
n
t
a
n
d
t
h
e
r
e
q
u
e
s
t
f
o
r
refund as the Permittee.
CITY USE ONLY
PERMIT NO.: Lw 1 &0 ..
ENTERED INTO COMPUTER BY:
TCP APPROVED BY:
DATE:
iNSURANCE CHECKED BY: EXP.DATE:
RECEIVED
OCT 21199?
ENGINEERING
APPLICATION RECEIVED
(ghto-W&y Permit Application)
Rev. 11115/96