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HomeMy WebLinkAbout7766 ANILLO WAY; ; RW000127; PermitCITY OF CARLSBAD - ENGINEERING DEPARTMENT APPLICATION RIGHT-OF-WAY PERMIT APPLICATION JOB 1/P3077 3573 JOB ADDRESS: 77 ' ' ,4Ji LL.,O lilJPcta. NEAREST CROSS STREET- L4AL4P Or. ASSOCIATED PROJECT NO.- — ASSESSOR PARCEL NO(S) DRAWING NO. (if applicable)T 1 14'7 f BRIEF DESCRIPTION OF WORK: T-&44 1-70')( L," x 3 i'ij hS?4-hørLf -' 11) VLAek I CDr B(&RIED EZt) W€ PROPOSED START DATE: 3Joo ESTIMATED COMPLETION DATE: to /b) CONTRACTOR NAME (Print or Type) PACIFIC BELL CONTACT PERSON: 4gAi4- MAILING ADDRESS:4220 ARIZONA ST., ROOM 100, SAN DIEGO CA 92104 PHONE NUMBER: (619) 574-4316 Fax# (619) 296-0127 24 HOUR EMERGENCY TELEPHONE:____________________________________________ STATE CONTRACTOR'S LICENSE NUMBER:______________________________________ STATE CONTRACTOR LICENSE TYPE:___________________________________________ CITY OF CARLSBAD BUSINESS LICENSE NUMBER:___________________________________ By its signature below, perrnittee 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. 3.7. b 43 SIGNATURE RIGHT d'i? WA MANAGER 1 ATE * CflY'USE PERMIT NO RW ,IM I ENTERED' INTO TCP APPROVED':BY:. INSURANCE CHECKED BY - DATE.•_ ThS1AMt.:. A16NRECEWED REV. 12/Wfl