HomeMy WebLinkAboutR2022-0059 - Permit ApplicationPrint Form City of Newport Beach ( /.
COMMUNITY DEVELOPMENT DEPARTMENT �4 N
BUILDING DIVISION {�
jpjun �,a r^� 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBRN FU`V 'J www.newportbeachca.gov ( (949) 644-3200 �tiv
wppncation Tor Keport OT Kesiaential Bullding Records
Application Fee: -$198.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $131.00 or incomplete will be returned
It of Units:
Please type or print and complete all information
Address:` } City: Newport Beach
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State: CA Zip:
Property Owner:
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Owner Address:
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State: CA
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Home Phone:
Owner's Authorized Agent: _'..- -�,r1
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Work Phone:
Agent Address:
City:
State: F Zip Code; F Agent Email Address:
Escrow Company:
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Escrow Address: J(,"1 �lW fL'j%l' City:
State:l ,1a. _ Zip Code: MOO) ) Escrow Phone: 10K-- jtD . cl4 ey-1
Email Report to: 1. 3336-byl)Z rw Vic.ifTi ,f~ ci�Ty)
For Inspection call (Name): Direct Phone: r
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 or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
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Date:
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Owner/Ageni'ssignature to decline inspection: Date:L-"L-
Account 71 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH
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