HomeMy WebLinkAboutR2021-0802 - Permit ApplicationCity of Newport Beach
COMMUNrrY DEVELOPMENT DEPARTMENT
BUILDING DWISION
Ma
6 a 100 Civic Center Drive I P.O. Bax 1768 1 Newport Beaah, CA 92656-8915
RSR# www,newportbeachea,gov 1 (949) $44-3200
Application for Report of Residential Building; Records
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# of Units: F 7� Address: I kv) `k 15 . City; Newport Beach state: E171p: °►2Q (k cj
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Owner Address: 1 &ikA UV Qtr. `�. ,Q,f,�� ,�•�
State: ZIP Code: "' Home Phone; tt ?,w �%
Owner's Authorized Agent:A1O- z Work Phone: RLt+ (I &Z qv
Agent Address: 6rk ' City; t ��
State: F'6�4 Zip code: ® Agent Emall Address; 101�n%Q .0 %eb DhNJQ�C.
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Small Report to:
For Inspection call (Name): Direct Phone: 71
CONSENT TO INSPECT (FORM MUST SE SIGNED & DATED BELOW)
hamthtrsize Inspectroris.andce•l ispection''ofthe property listed above. I understandthat if Bu.fldingorZoning.
vralationsare.discovered:I w ilPbd responsihi'e to correctsaid vrnlstis.ns,
Owner/'Agent's s{gnature•to•autho�rtze•rnsPecdi'am:
0Qoee$iAeed.by:
Owner/Ogen.Y'ss gmakuretu deciloe.tnspech{bn:
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• OC352C455E94448...
Account # 01050SO4-521040 .................Make checks payable tar C17Y OF NEWPORT BEACH
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