HomeMy WebLinkAboutR2020-0239 - Permit ApplicationSXCCEIVE'p 6y.
PnntForm City of Newport Beach coMMuNlry
COMMUNITY DEVELOPMENT DEPARTMENT °t'vfil-OPAIeNI
BUILDING DIVISION D�nnpp
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-1050 5 2020
RBR# �� -35 www.newportbeachca.gov 1 (949) 644-3200
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Application Tor tceporr oT tcesiaentiai tsuming
Please type or print and complete all information
# of Units: /� Address: 1 1 f I - _ -� City: Newport Beach State. CA )Zip ��,��j
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Property Owner: Tfwe Awl �'� Zip Code: F✓Z
Owner Address: city: -- -- - ---
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State:CA Zip Code: UPT-
I Home Phone._
Owner's Authorized Agent:I �) Work Phone: f��F� 7
Agent -- ' City:
State:Zip Code.
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Agent Email Address: �. p/"CQaQ,�/�% �j
Escrow Company:sc)6Escrow #. FTF
Escrow Address: c /�( � Ij� C-� 1 � City:v
-- - - -
State. �` Zip Code: 7_) Escrow Phone: i
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Email Report to: I ) $ �X--_7 Q, (G\ - -
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For Inspection call (Name): �(� Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the prqperqty listed above. I understand that if Building or Zoning
violations are discovered Iwill beresponsible torrects i violati n .
Owner/Agent's signature to authorize inspection: l k L Date:
OR
Owner/Agent's signature to decline inspection: Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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