HomeMy WebLinkAboutR2021-0584 - Permit Applicationr Y2 l.F'IVHt b: ,.
PrintPorrn City of Newport Bleach 'O
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COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMEW
BUILDING DIVISION AIIr,
W,1� /r 0 Civic Center Drive i P.O. Box 1768 j Newport Beach, CA92658-8915
118R# Yv p�(/� U L o �� www.newporibeachee.gov 1 (948) 644-3200
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Application for Report of Residential Building Records f114h,,., =Rc
Applicatlan Fes: - $198,00 Notice.
(For All Residential Buildings) Applications with insufficient fee payment
ReinspecIlan Fee $131.00 or incomplete will be returned
# of Units: Address:
i tftr Ty -a '�y"Y:w;.T".. City: Newport9each State:ZiP:
Property Owner;s'
VGee �'�t._.5 .i~�"*�r Zip Code:
Owner Address: "i l c.nirr,3'�t. T }(.... Eo w3 City::
State: Zip Code: t ^' :Home Phone: r DS—
Owner's
—Owner's Authorized Agenv . yC Work Phone: J ! t
Agent Address' csL..:. JACity....
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State:i Zip Code: $.'t ,� Agent Email Address:e--r s d..
Escrow Company: LXUk,.... e s Escrow #: FY9
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Escrow Address: O (.a7 %ewi y -s 164Jo i City:
State. F Zip Code: F -q- Escrow Phone tai --)4 6-- 41-3 0
Email Report to: 4pi i
For Inspection call (Name): j Direct Phone:
I authorize inspections and re -inspections of the propertylisted above. I understand that ifBuildingor'Zoning
violations are discovered l will be responsible to correct said violations
Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent's signature to decline inspection:
Date:
Account # 01050504.521040 ................Make checks: payable to: CITYOF NEWPORT BEACH
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