HomeMy WebLinkAboutR2022-0333 - PermitsCity of Newport Beach
COMMUNITY DEVELOPMENT DEPArVFMEKT
BUILDING DNISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach,
i'ma j www.newportbaachca.gov 1 (949) 544-32DD
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COMMUNITY
DEVELOPMENT
CA92658-8915 JUL 0 6 2022
CITY OF
Application for Report of Residential Building Records
%avvficatioa Fee^- $1 � q Notice:;
Fd[AILRicsiderrtFal.Byildfngs)' kppficati6nswith-irtsuffcient'fzepaymenG:
RernspeCion• F'ee:$S23AD ; ori'nrnrnpfete will:Se;netudnecl .
# of Units: FE Address:
Property
Owner Ac
State: ZIP code:
Please type or print and complete all information
Newport beach State: CA Z'rp:®
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Home Phone; I 011,ta 211-0
Owner`s Authorized Agent $$" (%vim (- work Phone: I q1-tel .(a ITC, -^ 9
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Agent Address: W 1Y�,, I Ct-Y: N rX } '; Q�Cc �
State: is 1 I Tip Code: .�, Agent Email Address: a fflhS U.Lit , C
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Email Report tn: f .f--i-,��.y (C'/( �Q.Y.%LI r� (,(W . UJr r 1 _ I
For Inspection call (Name): Direct Phone:
CDNSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
r-ar-ithor¢e Ir.Rspectrons.anrlre'ii spectioorn-afthe property fisted above. I un'derstaridtkaLff 15VAdingorloning.
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Owner/,4gent'ssigaatore'to autharrze-inspectiam: I• l�' `SPF'Q ��r�jN •
DR DECLINED n
Owner/Agen:C'ssigreafvre>a decfieeinspectinc�: Date: "11�^f� (j�
Account # 010S0504-SUD40 --- ..._--------- Make checks payable to: CITY OF NEWPORT BEACH
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