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HomeMy WebLinkAboutPALOMAR AIRPORT RD; ; RW970018; PermitCITY OF CSBAD - ENGINEERING DETMENT - APPLICATION RIGHT-OF-WAY PERMIT APPLICATION JOB #'IB7335 iB-I JOB ADDRESS: VKOMAK R'"o?—T -01kO PP$EP wwaft NEAREST CROSS STREET kk4AQA PL1 ASSOCIATED PROJECT NO. ASSESSOR PARCEL NO(S) JAN 28 1997 DRAWING NO. (if applicable) t 3 j ENGINEERING DEPARTMENT IV-64C44 DESCRIPTION OF WORK: t4CA4 4co' 3 , "ç 3o - •-r TkbIMC97 -r crnJ P'tr, C66CE 4- MPi 14o PROPOSED START DATE: I ESTIMATED COMPLETION DATE: o 8 CONTRACTOR NAME (Print or Type) PACIFIC BELL CONTACT PERSON: MAILING ADDRESS: 4220 ARIZONA ST., ROOM 100, SAN DIEGO, CA 92104 PHONE NUMBER: (619) 574-4316 24 HOUR EMERGENCY TELEPHONE:______________________________________________ STATE CONTRACTORS LICENSE NUMBER:__________________________________________ STATE CONTRACTOR LICENSE TYPE:_____________________________________________ CITY OF CARLSBAD BUSINESS LICENSE NUMBE By its signature below, permittee 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. _- 9-7 SIGNATUROr RIGhI OF WAY MANAGER DATE M. WW92