HomeMy WebLinkAboutX2019-1240 - Permit ApplicationX20(4 -1240
WORKSHEET FOR"ENCROACHMENT PERMIT
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
PROJECT ADDRESS: 2138 PORT DURNESS
DETAILED DESCRIPTION OF PROPOSED WORK:
REMOVE 14 S.F. OF EXISTING BRICK PAVERS IN PARKWAY.
REMOVE EXISTING MAILBOX AND PEDESTAL. REMOVE BRICK
PLANTER AT BASE OF MAILBOX PEDESTAL.
APPLICANT: GORDON RANDALL Phone: 949-640-0606
Email Address: Bordon@avalonarchitectural.com
Mailing Address:
18006 Skypark Circle
City/State/Zip:
Irvine, CA 92614
OWNER: Ken and Karen Kawaguchi Phone: 949-706-5598
Email Address: kkaren34@aol.com
Mailing Address:City/State/Zip:
2138 Port Durness Newport Beach, CA 92660
ALL CONTRACTOR INFORMATION IS REQUIRED -PLEASE COMPLETE
CONTRACTOR: Office Phone:
Company (if different): Jobsite Phone:
Other Phone:
Email Address:
Mailing Address:
City/StatelZip:
State License Number & Class:
Expires:
City Business License Number:
Expires:
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
Company: Policy No: Expires:
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FOR OFFICE USE ONLY
Special Conditions of Permit:
ADDITIONAL APPROVAL REQUIRED FROM THE FOLLOWING DEPARTMENTS
Utilities:
General Services:
Traffic: Fire:
Other:
Engineering Technician:
Public Works Specialist;
Date:
Permit No.
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Public Works Department 949.644.3311