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