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
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