HomeMy WebLinkAboutX2019-1859 - MiscCITY OF NEWPORT BEACH
MUNICIPAL OPERATIONS DEPARTMENT
592 SUPERIOR AVENUE
NEWPORT BEACH CA 92663
(949)644-3055
Demolition Hauler Certification and Deposit Form $2os�859
111 rh
Owner Name:
Property Address: 1/
Permittee Name. n - Phone.
Permit Number:
r
Franchised Hauler: <-A 7
Permittee I hereby certify that I have contracted with the above-mentioned City Franchised Solid
must initial Waste or Demolition Contractor. I also certify that I understand I must contact the
Municipal Operations Department at (949) 644-3064 no less than 24 hours or more
than 72 hours prior to my intent to commence demolition activities. Municipal
Operations staff will inspect demolition site and verify usage of franchised hauler.
City of Newport Beach Municipal Code indicates: A demolition permit deposit, as determined by the
Municipal Operations Director, shall be paid at the time of submitting the demolition permit. Said deposit
shall be returned to the permittee, at the conclusion of the demolition project assuming permittee follows
applicable laws.
Name: r'J , <� ,, K Lgj.
Address:
City, State, Zip:th (f
",v,
Permittee
Ex__
ttee) hereby :construction
at I understand that a City Franchised Hauler must For Finance Use Only
must sign to transport auction and demolition debris generated as a result ofand date lition referenve. I agree that the deposit will be forfeited if 1) a Cityd hauler is nto haul construction and demolition debris from thisr_2),1 f6ilNto ne Municipal Operations Department at (949) 644-les`s than 24 or more than 72 hours in advance of my intent toce �erpolitions.df?i fit Date "/ ..
t/
Far eltl9 " f j ....�
s aff Use Issued By: ! Date_.
For MoD Notification Date: Demo Date:
Staff Use
Hauler:
Distribution: White: Municipal Operations Yellow: Refimd. Goldenrod: Finance Pink: Applicant
Revised March 2018