HomeMy WebLinkAboutR2021-0408 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPAIKTME.NT
BUILDING DIVISION
i 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8915
RB R# B` IrU VV www.newportheachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
.'.[+vo6�tioo F'eec:-$: �q� • Notice:;
ForAll4tesideritial.Bui{di'ngs)' kpplicatibnswith.fnsuffcient fee•peyipent:
Rehrspection• F.ee7$52%001 oritrcnmp{ete will1e;6etnrned'
Please type or print and complete all information
# of Units: F Address: City; Newport Beach State: CA zip: —llitX
Property
Owner Address:
State: CA
Zip Cade,L 1Cv�LL Jl
Home Phone: . 2-0 - )�
owner's Authorized Agent: ° � ° (` Work Phone: I ClIq
Agent �Adddd`reessss . P ` o� Cdy:
State: L"JL�J Zip Code: Agent Email fir' s: �2
il Address: MRIA
WPM
Escrow Company: S Escrow #:
Escrow Address: City:
State: Zip Code:'--f+� Escrow Phone: 'I
Email Report to:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
('autlitrr ze Inspections.ancLre-inspection's af.'the property listed above. I understarid•that.if BuRding orloning.
violatinnsare.discovered'1 uuili be:respnnsihl'e.to correctsaid violations.
Owner/Agent`'ssignature•to•authordie irtspecdiaw
Date:. I
OR� '
Owner/Agee.C'ssigrtatuce4•o deciine.Insgectiba: Date:.'
Account # 010SCISO4-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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