HomeMy WebLinkAboutR2021-0310 - Permit Application— City of Newport Beach u. sa,:uNI TY1."
COMMUNITY DEVELOPMENT DEPARTMENT " f!t �OPP,,IE'NT'
BUILDING DIVISION E IIz
e�11 A2f��O D 100 Civic Center Drive P,O. Box 1768 Newport Beach, CA92658,�919 3 2021
RBR# www.newportheachca.gov 1 (949) 644-3200
for Report of Residential Building
Avotiiatibe Fee>:-$; Notice;:
(For.-AIL9tesrderit6i:B,uiidinp -,4p,PG'cationswith.i'nsufficLerrt•fee•CmYf??e
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#of Units: Addr w.IZAp)L0 Vwu o City: Newport Beach state: aZ'ip:
Property
Owner Ac
State:.u�
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Trp Code:. I 2,667L
Home Phone: I OL(4 1--W � U
Owner's Authorized Agent 1 Work Phane: /�'1 �i 0 uSO � j"] � 2
AgentAd�dress,:� 1�e7�ZCRy. "'�1 `L=t-+dL�
State: I (' Lk- I Lp Code: . Agent Email Address: 1� ,
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Email Report to;
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
pazti cns impectroris.andre-iiaspectionsafthe proo.rtylisted above. I rLodersdaridthatifBw'iding•wZoning.
vrWatiortsaredfscoverecrl W.111:Mraspnns'bleto comecCsacl vialations.
Owner/;4gant`s.Sagaatore'tn•authorixe�u•ispectiom: n�•A.,��
OR
Owner/AgeaC'sign-turetadeetioe.inspectraa: Date:: ^� `�.
Account # 01050504-521040 .................Make checks payable Ya: CrTYOF NEWPORT. REACH
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