HomeMy WebLinkAboutR2023-0466 - Permit Application® City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
DIVISION
100 Civic Center Drive I P.O. BUILDING
N 76B I Newport Beach, CA92658-8915
(ii3Rk 2'Zo23 - p��� www.newportbeachca.gov 1 (949) 644-3200
Application for Report Of Residential Building Records
Aaolica___ tio�pee.-_ $202.00
(For All Residential Buildings)
Reinspection Fee $134.00
COMMUNITY
DEVELOPMENT
MAY 3 0 2023
CRY OF
NEWPORT BEACH
Notice:
Applications with insufficient fee payment
or incomplete will be returned
Please type or print and complete all information
#of Units: I� Address: 3
1 - - - A City: Newport Beach State: CA Zip: 7
PropertyOwner: A
mar ON26 Owner Address: Zip Code:
City:
State: CA _ Zip Code: C Y �—
Home Phone:
Owner's Authorized Agent:
Work Phone:
Agent Address:
---- City:
State: Zip Code: _._..------
Agent Email Address:
Escrow Company: 1�I
-__Styx•-`�-�<.-- _—_ Escrow
Escrow Address: i1 n —
1�.��1.i��'j,�-- city
Stater Zip Code: %
Escrow Phone:
Email Report to:�� on.�,�........... . . .
For Inspection call (Name): ... ---
-_-- - Direct Phone:
CONSENT TO INSPECT FORM MUST BE SIGNED & DATED BELOW
I authorize inspections and re -inspections ofthe property listed above. I understand that if Building orZoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature to decline
Date:
Date:
Account # 01050504-521040 ................. ake ch s p ble to: CITY OF NEWPORT BEACH
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