HomeMy WebLinkAbout2601- 2615 LEVANTE ST; ; RW970005; PermitJN-08-197 14:38 519 295 0127 P.02/03
CITY OF cLSBAO - ENGINEERING DEPAVIENT
APPLICATION
RIGHT-OF-WAY PERMIT APPLICATION JOB # P3071 +47iO
JOB ADDRESS: h)C)! IS lfu&4m S
NEAREST CROSS STREET _ALta4A LA°r-'
ASSOCIATED PROJECT NO. ASSESSOR PARCEL NO(S)
DRAWING NO. (if applicable) _t& 1141 CS I
-
GRIEF DESCRIPTION OF I 1 I
it Cc*J92-r +
PROPOSED START DA MATED COMPLETION DATE:
NAME (Print or Type) PACIFIC BELL
CONTRACTOR
CONTACT PERSON:_
MAILING ADDRESS:4220 ARIZONA ST. • ROOM 100, SAN DIEGO, CA 92104
PHONE NUMBER: (619) 574-4316
24 HOUR EMERGENCY TELEPHONE:____________________________________________
STATE CONTRACTORS LICENSE NUMBER;________________________________________
STATE CONTRACTOR LICENSE r(PE:___________________________________________
CITY OF CARLSBAD BUSINESS LICENSE NUMBER;__________
By its signature below, permittee agrees to indemnify, -hold harmless, and defend the City of Carlsbad or
its officers or employees from all claims, damage or liability to persons or property arising from or
caused by an activity or work done pursuant to this permit unless the damage or liability was caused by
the sole active negligence of the City or its officers or employees. This agreement is a condition of the
issuance of a right-of-way permit,
e~04 Kk"~~b (/ 5 [.17
.SIGNATURE fO RIGHT MANAGER DATE
REV. I2.'24'92