HomeMy WebLinkAboutR2021-0398 - 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
RSR# [ D www.newportbeachca.gov 1 (949) 644-3200
Application tor Keport OT Kesiaenvai muuaing Kecoras
- AvoOcatiori Fee::-•$: �,q a _ • Nonce;;
(Foc�All!ResrdentFal.Buildings)' kpplicati'ons:withi'nsuffcient•feepeyrnent
Rerns0edion•Fee:$529:00: > - orinromplet'ewill:Fie;rieinrned' .
Please type or print and complete all information
# of Units: 1y ' Address: 1 o v h,A fttu-/ City: Newport Beach State: Dip: Z�
State: CA Zip Code: LTJ '
Zip Code:.
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Home Phone: 7-W 0 d 7-0
owner's Authorized Agent: L i7 Work Phone: 19X42,2,0 J02-0 1
Agent Address:
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State: L /9
l!_'_1—J Trp Code: � Agent Email Address: if �d � CCy"
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AVER 01971mva
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Email Report to:
For Inspection call (Name): Direct Phone:--�
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
tauth'arize Inspections.andre=inspection' of'the property 19sted above. I un'dersta:ndthat.if B'u.ilding or Zoning,
vialationsare.discovered'I wilhbe:responsibl'e.to correctsaW violations.
Owner/Agent:ssignature'to•outhaniie )nspectiam Date:..—�
OR
Owner/Agent'ssigntur6wcleciine.inspecti'on: Date:(` <"7Jta—
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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