HomeMy WebLinkAbout 17030109 Right-of-Way PermitT .
APPROVED
CITY OF CARMEL RIGHT-OF-WAY PERMIT
PERMIT NUMBER:D A// %-5 Carmel Engineering De
TODAY'S DATE: 73 -C- ) _ j ESTIMATED DATE OF WORK:
APPLICANT (Person doing the work)
COMPANY: j-9 0-�- t�c.s
ADDRESS: 3$�l L� 1Qrk.5 �.r �3S Reel LLA-etd 2iu i`( Id g
PHONE: 31j-"l!j_1t2s EMAILPERMITTO: MynI�IT
CUSTOMER: NO ee{n"f" YIYIi/V,2:
ADDRESS: 1X403 hbl� �in01� f.ClGlu �n^rvLr� J. 1 '%033
PHONE: 3) Z4•z9 m p I+
ADDRESS OF PROJECT: )R! 4)-� RC1 161;/A,1<tJ
DESCRIPTION OF WORK (check all chat apply)
ROAD BORE ❑ DRIVEWAY REPLACEMENT ❑
CONSTRUCTION ENTRANCE ❑ LANE CLOSURE ❑
STREET CUT ❑ ROAD CLOSURE ❑
OTHER ❑
DESCRIPTION: <In-yiil ip01-CC&- S,
TYPE OF SURFACE CUT (if applicable):
'NOTE: OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (SPW) APPROVAL'
USE OF HEAVY EQUIPMENT YES NO 8 DRAWING ATTACHED YES NO
`NOTE: ON REVERSE SIDE OF THIS PERMIT, PROVIDE NAMES AND CONTACTS OF ALL SUB -CONTRACTORS INVOLVED
SURETY BOND. Please see item kl of the Right -of -Way Conditions.
BONDING COMPANY: _ - - _ lilihKYli) INSI+,er4Nt'.•=
BONDING NUMBER: Ca-7 5 c:5
EXPIRATION DATE:
As applicant for this Right -of -Way Permit I understand and agree to oil of the specifications and
conditions listed on the attached sheet.
fflaM� MIkrt-
(Applica 's Signature) / (Print Na e)
PERMIT GRANTED BY: / %`-��'—� DATE ISSUED:
(City Official)
COMMENTS:
REPAIR WORK INSPECTED AND APPROVED
I have inspected the repair of the above right-of-way and find it to be completely satisfactory.
(City Inspector) (Date Released)