HomeMy WebLinkAboutR2020-0843 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658
www.newportbeachca.gov 1 (949) 6443200
Application for Report of Residential Building Records SEP 2020
AoalicationFee -$ -194..00 ': .'Nonce. L'I rV OF .
(For AlfResid'ential Buildings) .' Applications with insufhci$��t fee pagme t
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Reinspection Fee $129.00 efdl6eretu�n
Please type or print and complete all information
P of Units: ❑ Address: S 6 C• �. City: Newport Beach State: EIZip:�
)roperty Owner: h - Zip Code: 1 7iC� of
)wner Address: I R C&��i7 IIW71' I City
;tate: Zip Code: Home Phone:
Dwner's Authorized Agent: •L��L��l� - rn. Work 1%757— _ it
agent Address: E�� S City: 4 Z--
F77-1-7
State: C.Zip Code: Agent Email Address:
iscrow Company:' j'd % Escrow #: 11&77
Escrow Address: ,� iia -7-1- �1 ! City:
State: Zip Code:Escrow Phone:
Email Report to:
For Inspection call (Name): - Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re-icispecGons of.the p�pperLylisted above, I:understand that if Building drZoning
vielatiens are discovered 1 will be responsible to correctsaid violations,
Owner/Agent's signature to aulhorize inspection:
Owner/Agent's signature to decline
Account #
lwhim�omeion\Fa=AR8N_.9-3&18
Date:
Date:
checks payable to:
BEACH