Loading...
HomeMy WebLinkAbout2810 VIA OPUNTIA; ; RW000125; Permitk CITY'6Ft.ARLSPAD - ENGINEERING DEPARTMENT APPLICATION 'r1nK1 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 dALIBRAR;vooR�mDCkZViSFORMWRMX=a ("_v1_vftV Pwm Amexo dml.dw Rev. 11/15199'