HomeMy WebLinkAboutR2020-0866 - Permit ApplicationIREca;o+,Fo
City of Newport Beach C04,yLN�ry�'�
COMMUNITY DEVELOPMENT DEPARTMENT CT
BUILDING DIVISION ®e/j4(�{0
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 9265843
RBR# �Z620 - 0 66 www.newportheachca.gov 1 (949) 644-3200 0
Application for Report of Residential Building Records pORT BEPct�
- Avolimtion Fee:: -$:. �.q H Notice:;
(•Fo . Allkesidential.Buildingsj Applications:with. iirtsu�cientfee-payment:
Reinspection Fee:$,t29:00: or iomrnplete will. be: hefurned
Please type or print and complete all information
# of Units: I I F Address: `l Y' �� CIC �� I City: Newport Beach State: E]Zip: G- Z O
PropertyOwner: \ (?" ed S Zip Code:.
Owner Address: 1 r City:
State: Zip Code: Home Phone: M 0
Owner's Authorized Agent: Y rr C 1( �js
Agent Address:
M
Ad�dress�}3�� ' aQSAQ,
State: L I Zip Code: Agent Email Add
Work Phone: L1 q Zg Q S-S-iX 3 1
Fit
0 "117.11 RAM
L&.1 T'go"I ME
-WAS
— - WMWVM
Email Report to:
For Inspection call (Name): / Direct Phone: /
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Iauthorize inspections.and.re=inspections ofthe propertylisted above. I understand that.if Bu.fldingorZoning.
violations are. discovered] will be: responsibl'e.to correctsa:id viblatiDns.
Owner/Agentssignature-to authorize inspectiom:
Date:.—
OR
Owner/Agen.Y'ssignatureto decli[A.inspection: Dates:' I
Account # 01050504-521040 .................Make checks payable to: CITY Of NEWPORT BEACH
e�mm�Lo�.mo�1��s1Rar�s�e-u