HomeMy WebLinkAboutR2021-0256 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
nn jl/1�[ 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBS `LoG 6 (✓� www.newportheachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
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#ofUnits:l ' 1 Address: ) Qn rryme—ri U9P Oty: Newport Beach State: Zip:
Owner Address:
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Zip Code:
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Owner's Authorized AgentY J( n�h G Work Phone: q
Agent Address: s �X Y1 �'�' Oty:
State: Zip Cade: Ik�C. . Agent Email Address: r a t t CJS - ,i,A . (Ot-n
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Email Report to:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Pautha ize irespectiorss.andre�iiispectionsafthe properly fisted above. I anderstaidthatff F Rdineaorloning.
vialationsarediscovered:l Wflfberesponslhfeto correctsaid violations.
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/o0o„aGusIgned by:Owner/Aga9Vssigukure•t deciroe.inspecsraa: '''"` Date;
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Account # 01050504-521M ..... _...._....Make checks payable to: CITY OF NEWPORT -REACH
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