HomeMy WebLinkAboutR2020-0533 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# 'O C www.newportbeachca.gov 1 (949) 644-3200
AppnGaLion Tor KeportC oT Kesioenval ismaing Records
Application Fee: - $191.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
# of Units:) 1 Address. 1 C� I d Cor G 1e 1 City: Newport Beach ! State CA Zip
-- 1 .... _ _ ._ (f tu__
Property Owner SG����t �` L(2 e
-------------
Zip Code:
Owner Address lie- City:
State. CA Zip Code: p Home Phone C 73 if �..L�
Escrow Company: a Escrow #
Escrow Address ) CA T I
-- - --� -s-IT-1.23-0- City: 1. 1-
State. C A Zip Code L1 L_ T+ic(1 Escrow Phone: _-_ qq -__57
Email Report to:
For Inspection call (Name): Direct Phone.
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Date:
OR
Owner/Agent's signature to decline inspection: Date: 13j Lv
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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