HomeMy WebLinkAbout2810 VIA OPUNTIA; ; RW000125; Permitk
CITY'6Ft.ARLSPAD - ENGINEERING DEPARTMENT
APPLICATION
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A
RIGHT —QF-VVAT H=KMI I Ar-r-Liv—,
C
"Juts ADDRESS.
NEARES7 CROSS STREET
ASSESSOR PARCEL NOP: �25
ASSOCIATED PROJECT NO
DRAWING NO. (if applicable): ' ,
BRIEF DESCRIPTION Or WO'F\
PROPOSED START DATE: ESTIMATED COMPLETION DATE:.
CONTRACTOR (Permittee.)
'NAME, (Print or Type):,
,'CONTACT PERSON:.
-MAILING ADDRESS:
PHONE NUMBER:
24 HOUR EMERGENCY TELEPHONE:"
STATE CONTRACTOR'S LICENSE -NUMBER:/ 'D& -7
STATE CONTRACTOR'SI LICENSE TYPE:
CITY OF'CARLSBAD. BUSINESS. LICENSE NUMBER:,
ignature.below, in' City of Carlibad or
By its s permittee agrees -to dimnify, hold harmless, and defend theC!
"'
it . s officers or employees from all,`cfaims, damag6 or"11abilit to persons or arising,'from or
, .y
caused by an activity or work done pursua I nt to this permiUunless the damage or liability was CaUS68 by
the sole active neglige I nce of the City, or its officers or employees. This agreement is a conoition of•the.
issuance of a right-of-way permit.
I
ClIt"2KIAT" C DATE
The same name must appear ' on this application, the. C,
refund as the Perm.ittee.
Security Agreement and the request for
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Rev. 11/15199'