HomeMy WebLinkAbout07080137 Right-of-Way Permit03/201 07 T-UE 13:25 PAX 317 571 2639 City of Carmel
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COOPY,
Note: Open cuts in pavement require Board of Public Workr and Safety (BPWS) Approval.
LOCATION OF CUT/WORK: CL ; S? !}Cs; tit C1?Ll? CqvA?- L, t 1J (,03 Z
TYPE OF SURFACE TO BE CUT:
PURPOSE OF STREET CUT/WORK: ?}C CEs? ?o C5U' ?p ?J. ?C
DATE OF PERMIT:
ESTIMATED DATE OF WORK:
APPLICANT'S NAME NZ C&&-- U)WC L t L "?icvJtC PHONE: S1Z ygioo
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ADDRESS: 0l N. M)GU'5'Cq q-D CAVAE,L t
WHO IS APPLICANT DOING WORK FOR: (name) :So40 L2a C
ADDRESS: IZQ? UA-c,lt? CAo-wP_ Lr? LA?,03L PHONE: 14`0'Ab'4`0
NOTE: UNDER SEPARATE COVER, PROVIDE NAMES AND CONTACTS OF ALL SUB-
CONTRACTORS TO BE INVOLVE N N-SITE WORK ON THIS PROJECT.
PERMIT ISSUED BY: (Signature)
SURETY BOND AMOUNT:
BONDINGCOMPANY: StWrt?, IVTo SN?vlti ?t c- CuM?>rJ1?J
As applicant for this right-of-way/street cut permit, I understand and agree to all the specifications and
conditions listed on the reverse side of the
?pU.ItIA. r.?ItiJ it? ItlESl t)E NT ? ? ?i--
(Applicant's Signature)
I have inspected the repair of the above right-of-way/street cut and find it to be completely satisfactory.
(City Inspector)
(Date)
If applicable:
Check returned: By: