HomeMy WebLinkAboutR2020-0878 - Permit Application�vIVEi:1 gi.
Print Form City of Newport Beach � nsvuunit+ ,
COMMUNITY DEVELOPMENT DEPARTMENT )EVF1-0PIv1[ N1
BUILDING DIVISION '1f 1 o P 202117 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658'-891
0 �^%�(� `^'ww.newportbeachca.gov 1 (949) 644-3200
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Applicatlon for Report of Residential Building
Application Fee: - $-1-9170& iC(q.00
(For AIIResidential Buildings)
Reinspection Fee $129.00
Notice:
Applications with insufficient fee payment
or incomplete will be returned
Please type or print and complete all information
# of Units: IT7 Address: 1 I I11T SAC 1...1Y IUCJ City: Newport Beach State: CA .Zip: xae-
PropertyOwner:I i f IGI K V N1iQ(1/1
Owner Address: I City:
State: CA Zip Coder
Owner's Authorized Agent:
Agent Address:
State:
Escrow Company: I �tya
Zip Code: F
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Work Phone:
City:
Agent Email Address:
EscrowAddress City:
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State: Zip Code: / iEvo
Email Report to: 16 U 4ZA/ evo I 1 L y4l ,
For Inspection call (Name): I n/IGi
Zip Code:
Escrow #: iJ `
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Escrow Phone:
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:
Date:
Owner/Agent's signature to decline inspection; Date: lel i
Account # 01050504-521040 .................Make checks payable to: CITYOF NEWPORT BEACH