HomeMy WebLinkAboutR2021-0366 - Permit ApplicationPrint Form
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
/p /� 00 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-8915
RBRI# �Lo��'U � www.newportbeachca.gov 1 (949) 644-3200
Application Fee: - $194.00
(For AIIResidential Buildings)
Reinspection Fee $129.00
for Report of Residential
Records
Notice:
Applications with insufficient fee payment
or incomplete will be returned
Please type or print and complete all information
#of Units: Address: 1 & 6 3 1P l Yv C City: Newport Beach State: CA Zip: %TO
PropertyOwner: b) % V II O �SE i Zip Code: 00
Owner Address: 10610 { ijt �t'' vt✓ City: f3 c—r4f (i
State: C`A Zip Code: z66o Home Phone: 114 ^ / 4. % ^ 9 t q i
Owner's Authorized Agent: I X oa r1�(f� ow6 Work Phone: ? L� _ 2 R _ G (o
Agent Address: 17 Zd P C h/ 6 + Gti': HU&J1q1Vq--T-4 AJ 61 �V
CA —Zip
State: Code: %a G Y E./% Agent Email Address: C2 ep //�( E g
Escrow Company: PP-o G-t? S 51 (J e t—�jC (G %.J t 7�: l,j e Escrow #: Q O 1 ^ 1A
Escrow Address: 4 PJ (R/i 1 /})-(♦ 64?-7 P-b -�W b City:
State: Zip Code: <f-r2 9
Escrow Phone: I'7)(- 521,E Z l 4 1
Email Report to: I %/v 0k1\17 6 %( - /6M 6 SA (, ES , LQ) %� For Inspection call (Name): / i/ Direct Phone: q1 y a
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. I understand that if Building orZoning
violations are discovered [will be responsible to correctsaid violations.
Owner/Agent's signature to authorize inspection:
owner/Agent's signature to
Account
BUJ1dln"1V151BBW1MSXflBflJ80.20
Date: I
Date: 3 ��
checks payable to: CITY OFNEWPORT BEACH