HomeMy WebLinkAboutR2022-0024 - Permit ApplicationCity of Newport Beach
COMMUNrrY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
yln ^�n oOI Do Civic Center Drive I P.O, Box 1768 ( Newport Beach, CA 92658-8915
www.newportheachoa.gov 1 (949) 644-3200
Application Tor Report OT Keslaentlal munaing Kecoras
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# of Units: IFTJ I F Address: S Va City: Newport Beach State: Dip: L4
Property Owner: V i V' Zip Code..
Owner Address:y- a �V���,—Q[- /c v
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State: Zip Code: Horne Phone: Z ZU I C) Z
Owner's Authorized Agent: Jk'y \(e)V (% s G Work Phone:
Agent Address: Zoa DY clty Nggm+ gP�tGv1
State: J Zip Code: " �,� Agent Email Address 0
Email Report to:
For Inspection call (Name): Direct Phone:
CONSENT To INSPECT (FORM MUST BE SIGNED & DATED BELOW)
r author rze lnspectrons.and re,itispections ofthe property IFsted above. I understand•that.if B'uRding or Zoning.
viblationsare.discovered:l Will:be:responsibl'e.to correctsald vraletions.
Owner/Agents signature•to-authonize.fnspectron:
Date:f
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Owner/Agen.essignratwmta dec6neInspectibn: Date,. �Z J
Account # 01050504-521040 .................Make checks payable to; CITY OF NEWPORT BEACH
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