HomeMy WebLinkAboutROW Permit - Building 1PERMIT NUMBER: _[�O / �j -/
�TODAY'S DATE: 10/24/2019
ESTIMATED DATE OF WORK: 11i05-20 � �+
APPLICANT (Person do+ng the work)
COMPANY: DB Klain Construction
ADDRESS: 2159 Giebe Street, Suite 200 Carmel. 46032
PHONF: (317; 846-9992 EMAII PERMIT TO: tmarcus@dbkla�r com
ICUSTOMER: same
ADDRESS:
PHONE:
ADDRE55 OF PROJECT: 2149 Glebe Street Carmel. IN 46032
DESCRIPTION OF WORK (check all that apply)
ROAD BORE [� DRIVEWAY REPLACEMENT
CONSTRUCTION ENTRANCE [�✓ LANE CLOSURE
STREET CUT Q R�AD CLOSURE
OTHER D
DESCRIPTION:
�.
�
TYPE OF SUR�ACE CUT (if applicable):
#IVOTE: OPEN CUTS !N PAVEMENT REQUIRE 80ARD OF PUBL/C WORKS (BPW) APPROVAt `
USE OF HEAVY EQUIPMENT YES 8 Np n
DRAWING ATTACHED YES �/ NO �_ j
*NOTE: ON REVERSE SIDE OF THIS PERMIT, PROUIDE NAMES AND CONTACTS OF ALL SUB-CONTRACTORS INVOLVED
SURETY BOND. Piease see Item #1 of the Right-of-Way Conditions.
BONDING COMPANY: Vernon General
BONDING NUMBER: VLI -i00889
EXPIRATION DATE: 11/09i202�
As applicant for thrs Right-of-Way Permit, i understand and agree to ail of the spec;,�i�ctrons and
conditions listed on the attached sheet.
� >�:���.�� %•_ ;� t-� c.� �� ��c� N� i ,� ic�.r�c.�..'S
(Applicant's Signature} (Print Name)
�PERMIT GRANTED BY:
�COMMENTS:
(City Officiai}
..�� DATE ISSUED: jl
�
�i�
REPAIR W�RK INSPECTED AND APPROVED
i have inspected the repair of the above right-of-way and find it to be compieteiv ;arsfactory.
(City Inspector)
(Date Released)