HomeMy WebLinkAboutR2021-0203 - Permit Application,x�.t�IVFiJ Sy..
City of Newport Beach c"INQ10NITY
COMMUNITY DEVELOPMENT DEPARTMENT. ,r \ Leo?M6 N)
BUILDING DIVISION MAR 15 2021,
�MgO Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-891
sR# �`jj www.newportbeachca.gov1(949)644-3200
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Application for Report of Residential Building Reco a
Application Fee::-taSILDIJ Notice,;
(For. All!RBsrdential.Build[ngs)' Appllcati'ons:with.ihsufficient,feg payment:
kernspection Fee:$.12%00: or hycomplete will: he: retnr.'ned:
#of Units: F7 Address:
Please type or print and complete all information
City: Newport Beach State: FCA Zip:�
Property Owner: Zip Code:.
Owner Address:12%r-' d I city: 6
State: CA Zip Code: Home one:
Owner's Authorized Agent: r Work Phone:
Agent Address: Civil-,
Or.
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State: = Zip Code:Agent Email Address: •Tra t�%/ I /;,j i� e ? Nmai- 1.
Escrow Company:/�� ; Escrow
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Escrow Address: Uv tAW -Vl1 `-''.�1i1 • -` • �I !ty: I�dr s bb
State: Zip Code: �-f Escrow Phone: . l
Email Report to:
For Inspection cal
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Ia.uthorize inspectionsand.re4mspectionsof-the property listed above. I understandthat.if BG.11dingorZoni:ng.
violations are.discovered'I will be:responslbl'e.to correctsaid viblat(nns.
Owner¢Agentssignature to authoniie inspedl'an: oatec
OR
Docuftnetl by:
Owner/Agentssigneturetodecirne:inspection:� Dater 3/17/2021
2686F42667aA431...
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Bu11d1ng_DMslan\Forms\NBR 9-1&10