HomeMy WebLinkAboutR2021-0724 - Permit ApplicationCity of Newport Beach
COMMUNrrY DEVELOPMENT DEPAPt MENT
BUILDING DIVISION
�� 1 I� O1 9 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92659-89i5
RBR# I/ l L www.newportbeachca.gov 1 (949) 644-3200
Appucation Tor report or Kesioenuai ounuing necuvub
:. Appuiztib6 Fee::-$1 !cis • Notice;: '
. (For.'AIIPtesrderitia4.Buiidings)' Appiicati'onrwith.insu{{rcieert•�epeyire�rt
Reinspeo:ion F.ee:$f29:00� arihmmplete wlll:tie;mtura d'
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all Information
# of Unh: Address:
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Oty: Newport Beach
State: EZlp:
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Property
Owner Ac
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Home Phone: IgLA 2,2 V
Owner's Authorized Agent: o Work Phone: A WA I - 3�
Agent Address: Vv W City:
State: Z:p Code: 41 Agent Email Address:
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Email Report to:
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Far Inspection call (Name): t7\ Direct Phone: ?j 3
CONSENT TO INSPECT !FORM MUST BE SIGNED & DATED BELOW)
rauthadl7e inspections.andre=iaspectionsofthe property fisted above. I anderstaridthaii B'u.iidingorZoning.
violatinrksarediscovered'I wrill�beresponsihl'e.to corre�rMaid viDtations.^
OR
Owner/Ageat'ssigr.raturetD deciine.inspertraa,
Account # D1050504-521040 .................Make checks payable to: C+TY OF NEWPOKT BEACH
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