HomeMy WebLinkAboutRight of Way permit.pdf�
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1�Iaie: Open c�ts it� gavet�e�t require �oard of ��ablic 'uVorlcs (��V4� Apg�°ov.at � ; ; � , ;,� � , _
ADDR.ES S OF WORK, z�7 �� � i � 51 �!, c� _.�V►�',P..G'�' ,........_. ��l,✓ rM.e. �, )N � 6 b�j Z
DESCRIPTION OF WORK (c�eck all that apply}; iLoad Bor�
Street C�t Driveway RepIacement Lane Closure
Construc#ion En�ance
�oad Closure Other �
�T�E OF HEAV�' EQUIPI�ENT (yes or nn): � 5 IF YES, T'YPE �F HEAVY EQUIPIVXENT (Bobcat or
�arger} TO �E USED: � t��
T�DAY'S DATE: �{ blo 1`'� ESTIMATED DATE 0�' 'GI�ORK: QT � p Za 1
TI'�'E OF SURFACE TO BE CUT (if applicable); N
�P��,���N�''S R?�4.ME (Person do�ag khe work}: �'t,�� j•t14K [�U�C' ��� Phone: 3��f — Z. Z q 8
A�dress: �,•�i�(o W. ! a 3 r=� �3 e5�ie1� JIV b"75�
'6WH� i� �P�.���I'�` IiOING WQ� �`C3�: Name: l �3 �C'�.P•r.�-Z� e r,� C.
Address: �i � f L! 5 b ��v�, s+�t. GcrvhQl Phane; Z, $(' ZD lo/
DRAWiI�G ATTACHED {yes or na) G S
NOTE: 4N REVERSE S�E �� TI'!IS PERMIT, PROVIDE NAMES AND CONTACT,S OF ALL SUB�
CONTRACTORS TQ �E INV4LVED IN ON-SITE WORK QN THZS PROTECT.
SURETY BOND: Please see Item #1 of the Right af Way Conditians
BONDII�G COIVIFANY: � t�$+l% M�•c. �cci.I BONDING #�j b f o�-i � r�
As applicartt for thls r°fght-�,f=way perr�tit, I understar�d and agree to all fhe specaficadions and conditions
listed an the attached sheet.
.
{.4pPlicant's ,Signat re)
PER�vIIT GR�4NTED BY: � �
(City 4ffic' {Dat� ssued)
��� 'Vt►'Q� �h'S��C�'�D �Ir1� A�PItQ�VE�
T have inspected the repair af the sbnve right-of way and find it to �e comp�ete]y satisfactory.
�City Tnspectox)
John McKenzie
Owner/President
john;R:mckenziecollection.corr�
O 317. 7A.7616 ex Y,1 Dl
C 377.�81.7061
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4631 Lisborn DrEVe
Carmel. lizdiana 46633
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NfCKENZIECOLLECTION.COM
(Date Releasedj