HomeMy WebLinkAboutR2020-0522 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT �yGEiV,�L @y
BUILDING DIVISION COMMUNITY
..pp�� � h n 100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA9 118§1``—NT
RBRiit"W N/ .V 521/ www.newportbeachca.gov 1 (949) 644-3200 JUN 2 6
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Application for Report of Residential Building Records
"(Y OF
Application Fee: - $191.00 Notice: 41�j�
(For All Residential Buildings)' Applications witFffd1offirie tee payment
Reinspection Fee $129.00 or incomplete will be returned
Property Owrer:��......1.\MO'T1�... �Ua�ll ...._.. __._._ Zip Code:—q'ZCi(p:
Owner Address: �LpQ® 1' I�nOG�..,.. City: L�gwoo�
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State: Zip Code: Lp if ZO (0 Home Phone: G �3 _lo� - -79:37
Owner's Authorized Agent: G \ Work Phone:2 L qC1 7,
Agent Address [ CAll T r)iel ..Avt __. Gty'I.......... O6C.1'7A
State: FKT- Zip Code: � I Agent Email Address:
��qn G (YILiCe�Cj/�"
Escrow Company: �... �Q 5 C
11 �}} rO. rV Escrow #:I G -71 � S - c'�
Escrow Address: ��ZQz CGL'J t �4 Z��, city: �gUflq lVl.�y( A
o.
State: FifA Zip Code: ciiu� i Escrow Phone: _l.Pz5—CD�5
Email Report to:
For Inspection call (Name): Direct Phone:
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:
Owner/Agent's signature to decline inspection:
BUIIdIn�ON41on?Fwms\RRR_31&1R
OR
Timothy S. Dunn
Date: F
Date: 06/2S/20
Account # 01050504-521040 ................. Make checks payable to; CITY OF NEWPORT BEACH
Please type or print and complete
all Information
# of Units: F—Address `."
,;' City: Newport Beach State:
Zip: z i p bo
l" c k ,0 �d,.'Df 53
Property Owrer:��......1.\MO'T1�... �Ua�ll ...._.. __._._ Zip Code:—q'ZCi(p:
Owner Address: �LpQ® 1' I�nOG�..,.. City: L�gwoo�
r--�-- _.nn
State: Zip Code: Lp if ZO (0 Home Phone: G �3 _lo� - -79:37
Owner's Authorized Agent: G \ Work Phone:2 L qC1 7,
Agent Address [ CAll T r)iel ..Avt __. Gty'I.......... O6C.1'7A
State: FKT- Zip Code: � I Agent Email Address:
��qn G (YILiCe�Cj/�"
Escrow Company: �... �Q 5 C
11 �}} rO. rV Escrow #:I G -71 � S - c'�
Escrow Address: ��ZQz CGL'J t �4 Z��, city: �gUflq lVl.�y( A
o.
State: FifA Zip Code: ciiu� i Escrow Phone: _l.Pz5—CD�5
Email Report to:
For Inspection call (Name): Direct Phone:
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:
Owner/Agent's signature to decline inspection:
BUIIdIn�ON41on?Fwms\RRR_31&1R
OR
Timothy S. Dunn
Date: F
Date: 06/2S/20
Account # 01050504-521040 ................. Make checks payable to; CITY OF NEWPORT BEACH