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HomeMy WebLinkAboutR2022-0142 - Permit ApplicationPrint Form City of Newport Beach COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION /11 , / /J 100 Civic Center Drive ( P.O. Box 17681 Newport Beach, CA92658-8915 RBR# (�I� U _I' 1� www.newportbeachca.gov 1 (949) 644-3200 Application for Report of Residential Building Records Application Fee: - $194.00Notice; (For All Residential Buildings) Applications with Insufficient fee payment Reinspection Fee $129.00 or incomplete will be returned Please type or print and complete all information #of Units: a Address: 419 A46 -mo -o A City: Newport Beach State: Frp:� Property0wner. KGEpN a •HGNglu Zip Code: Owner Address: /225 NltJ I�AVE/V/aQ4% f4City: $�JD State: P�L-A Zip Code: � one: f 4/9_ 23g- // 8lp Owner's Authorized Agent: ZVW4A Work Phone: Agent Address: /Of 1jbuloini City: State:© Zip Code: /(2: Agent Email Address:T�t/D�a-�'f►INf3�lLIOf;�9 CQ/h J Escrow Company: I%E d/V6 �5 , J/VG . _J Escrow #: Escrow Address:18 9 2 f S. S&PPZVeDA &110 � City: SOS ANG'B4ES' State: �'� Zip Code: 9DQ f�J' '� '�� Escrow Phone: 131,0 -2,3/ -II OD Email Report to: For Inspection call (Name): DeifnJA, l Qr(,tenalZ_ Direct Phone: 3/p- f .11 00 -1 X CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOWI /l41" I authorize inspections and re -Inspections of the property listed above. I understand that if Building orZoning violations are discovered i will be responsibleto correctsald violations. Owner/Agent's signature to authorize Inspection: OR „ Owner/Agent's signature to decline lnspectld���'�/!2.- ��( / Date: �— Date: 13/ Account a u1uSu5u4-5z1u4u .................Make checks payable to: GTYOF NEWPORT BEACH e0d1A&WdWVa %RBL7.30-20