HomeMy WebLinkAbout6711 LEMON LEAF DR; ; RW000171; PermitCITY OF CARLSBAD -ENGINEERING DEPARTMENT
APPLICATION
r RIGHT-OF-WAY PERMIT APPLICATION
-JOB ADDRESS: (fl] -tMJ (.4CA14
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NEAREST CROSS STREET C,4i4) Pit 64-Jr a '4i
ASSOCIATED PROJECT NO ó /J7 V ASSESSOR PARCEL NO(S) LI '/
DRAWING NO (if applicable)
BRIEF DESCRIPTION OF WORK L... .56*
PROPOSED START DATE ,4-5Af ESTIMATED COMPLETION DATE
CONTRACTOR (Permittee)
NAME (Print orType) f1e5/'v.) (14 JPAJC CJIAS,
CONTACT PERSON cf 2-8
MAILING ADDRESS: g,1_&'( P 4(6(.-s-4)14L Al).
PHONE NUMBER 6 V-7
24 HOUR EMERGENCY TELEPHONE
STATE CONTRACTOR'S LICENSE NUMBER:
STATE CONTRACTOR'S LICENSE TYPE:
CITY OF CARLSBAD BUSINESS LICENSE NUMBER / '2_c 4
By, As signature' beIo', permittee agre to indémnify, 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 negligeñcé of the City or its officers or employees. This agreement is a condition of the
issuance of a-right-of-wa permit.
SIGNATURE DATE
The same name rriust appearon this application, the Cash Security Agreement and the request for
refund as the Perittee. .
(PJWiy P.,,.
S.
TD c$
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