HomeMy WebLinkAbout12646 Brandenburg Row permit applicationRIGHT-OF-WAY PERMIT
PERMIT NUMBER:
TODAY'S DATE: I 19 ESTIMATED DATE OF WORK:
APPLICANT (Person doing the work) �oo�s o¢ T --o,
COMPANY:-Poo_,s of F�
ADDRESS: 3Q�o11 Gt WRx S C�zE1C 1zD•
PHONE: 31 1-Qj3g 33I I EMAILPERMITTO: 1L�EN.H��oFc� �.cA
CUSTOMER: SOLI , Vq J��fNE�
ADDRESS: l2laJ ly T3Q a �c rs�rt �, pu ,
PHONE: Lp51- g°1S' 2�t So
ADDRESS OF PROJECT: )21p f C. 3Tcan+acvTS�2�o n5�
DESCRIPTION OF WORK (check all that apply)
ROAD BORE _� DRIVEWAY REPLACEMENT U
CONSTRUCTION ENTRANCE LANE CLOSURE
STREET CUT J ROAD CLOSURE L_
OTHER
DESCRIPTION:
TYPE OF SURFACE CUT (if applicable):
*NOTE: OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL*
USE OF HEAVY EQUIPMENT YES NO 6-.01-x- �oT7cv.T
DRAWING ATTACHED YES Y NO Inl
*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: Qesl-FIet_.
BONDING NUMBER: U7 5-0) - S(.erb
EXPIRATION DATE:-Z�I.-ZO
As applicant for this Right -of -Way Permit, 1 understand and agree to all of the specifications and
conditions listed on the attached sheet.
-IPbowoFF".,a IC,,L, bT ,+__1 'F�OoL_% of 7=o.
Ap licant s ignature (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)