HomeMy WebLinkAbout95N - ROW Permit ApplicationCITY OF CARMEL RIGHT-OF-WAY PERMIT
PERMIT NUMBER:
TODAY'S DATE: 7/17/11 ESTIMATED DATE OF WORK: $/ 7/ 19
APPLICANT (Person doing the work) WIP4gcti.D-C) LL.�, co
COMPANY: wed,5e�,--d ff-W-tip
ADDRESS: 3 Z Flrrf j',} NIR
PHONE: ?17 (61-(a31S- EMAIL PERMIT TO:Perni)s�%a 4¢)�e ✓•c ryC, 6* 1
CUSTOMER: C�4rne qr ybuV.
ADDRESS:
PHONE:
ADDRESS OF PROJECT: 13 I V 12 D,;Ye
DESCRIPTION OF WORK (check all that apply)
ROAD BORE ® DRIVEWAY REPLACEMENT r _
CONSTRUCTION ENTRANCE ® LANE CLOSURE ❑
STREET CUT ® ROAD CLOSURE ❑
OTHER n
DESCRIPTION: New 60r¢ Co ^rir_c'1
TYPE OF SURFACE CUT (if applicable): n A
*NOTE: OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL*
USE OF HEAVY EQUIPMENT YES NO e
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 #1 of the Right -of -Way Conditions.
BONDING COMPANY: Lfiber*., ?A 4",k
BONDING NUMBER: 6IB If
EXPIRATION DATE: 3 3 2 a 2 0
As applicant for this Right -of -Way Permit, l understand and agree to all of the specifications and
conditions listed on the attached sheet.
N,l Ati.p^dt
(Applicant's Signature) (Print Name)
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)
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