HomeMy WebLinkAboutR2020-0529 - Permit ApplicationPrint Form City of Newport Beach
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COMMUNITY DEVELOPMENT DEPARTMENT
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BUILDING DIVISION JUN 2 9 020
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-891
RBRZow 052 www.newportbeachca.gov (949) 644-3200
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Application for Report of Residential Building
Application Fee: - $191.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Property Owner. ecly-okv\z L - N Y.ir :W)s
Owner Address:
State: CA
Owner's Authorized Agent:
Agent Address:
State:
Zip Code: F
Zip Code: F
Escrow Company: I --YAWJ ec.Yl�
City:
City:
Agent Email Address:
Escrow Address: f U ll\K*j1+ G�AiPN D
State: Co Zip Code: FqAtckb
Zip Code:
Home Phone:
Work Phone: I q,l-q, -355 - �( (
Escrow #:I Ub7J�14- �Frj
City: We6d oot
Escrow Phone: I 949 -COL 1- 3rl�o
Email Report to:
For Inspection call (Name): I N IIA Direct Phone: I i
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) t
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:
Date:
OR
Owner/Agent's signature to decline inspection: / (Date: F
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Please type or print and complete
all information
# of Units: Address:
City: Newport Beach State:
CA Zip:
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Fc-y-rr1l caf N- .
Property Owner. ecly-okv\z L - N Y.ir :W)s
Owner Address:
State: CA
Owner's Authorized Agent:
Agent Address:
State:
Zip Code: F
Zip Code: F
Escrow Company: I --YAWJ ec.Yl�
City:
City:
Agent Email Address:
Escrow Address: f U ll\K*j1+ G�AiPN D
State: Co Zip Code: FqAtckb
Zip Code:
Home Phone:
Work Phone: I q,l-q, -355 - �( (
Escrow #:I Ub7J�14- �Frj
City: We6d oot
Escrow Phone: I 949 -COL 1- 3rl�o
Email Report to:
For Inspection call (Name): I N IIA Direct Phone: I i
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) t
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:
Date:
OR
Owner/Agent's signature to decline inspection: / (Date: F
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH