HomeMy WebLinkAboutR2022-0008 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
loll �J , 66 * D0 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBR# G ` l/ _ www.newp(3rtheachca.gov 1 (949) 644-3200
Application for KepOrL OT KeSIUL-MTat puuaing r%CL JI ub
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# of Units:1 7 I Address: 1 City; Newport Beach State: Zip: AWT -57-
Property Owner• v ahk kv- YZ V Zip Code:.
Owner Address: Ot`• �//� � eA
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State: CA ZIP Code; Home Phone; ..L� I U ZV
owner's Authorized Agent(jd Work Phone: p &SR -1
Agent Address: y , City;
State: Zip Code: Agent Email Address:
Escrow Company:
Escrow Address:
State: EU
Email Report to:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
tauthcn ize inspections.andre=inspectionsaf••the property listed above. I understand-that.6f Ru.nding orZoning.
vihlationsare discovered:) WillbLixesponsihl'e.te correetsaid viblations.
-Owner/:4g�nt`.ssignatore•to•authu�rtieinspectiam: Date:.—L
Owner/Agent'ssigmaturetD decilae.inspectibm:
Account # 01050504.521040 .................Make checks payable to: CITY OF rvewrOe I ISLALM