HomeMy WebLinkAboutR2020-0958 - Permit Application0,lilveb F11.
City of Newport Beach �.OMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT '� Vffl OPMENt'
BUILDING DIVISION NOV �, U 2a2n
A 100 Civic Center Drive P.O. Box 1768 Newport Beach, CA92658-8915
www.newportheachca.gov (949) 644-3200
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- Application Fee::-$: Iq Ll � � � � Notice:;
(FocAll.4iesidential.Boildmgs)' Applications; with. ihsuff cientfee payrnent
Reinspection Fee:$.129:001 orincorrplete will: be: iieturned
Please type or print and complete all information
#ofUnits: I 1 ( Address: �• C) CA /UVB/-,... City: Newport Beach state:
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State: CA
Owner's Authorized Agent:
Agent Address:
State: F
Email Report to:
Home Phone: �'��, 'U,1 - L ZD
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MWAITITZ "102 AV
A 0 NO R —AM W701 7
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For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Fauthorree inspections.and.re=inspections afthe property listed above. I understand that.if B'uf1dingorZoning.
violations are.discovered'I will be.responsibl'e.to correctsaid viblatinns.
Owner/Agents signature to -authorize inspection: Date..)
OR
Owner/Agent.'ssignature to decline.inspection: Date_ i r.
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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