CITY OF STAFFORD, TEXAS
Application for Registration
Construction In Right-of-Way
Name of Applicant _______________________________________________________________
If Company, Name of Representative
Title of Representative
Address ________________________________________________________________________
City State Zip
Office Phone _________________________ Cell Phone
Fax Number Email
Contact Individual
Street Address
City State Zip
Office Phone Cell Phone
Fax Number
Liability Insurance
Policy Number
Company Representative:
Printed Name
Signature
Date _________________________________________________
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signature
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