HomeMy WebLinkAboutR2021-0219 - Permit ApplicationCity of Newport Beach
COMMUNMY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
/� t@ 1D0 Civic Center Drive I P,O, Box 17BB 1 Newport Beach, CA926SM915
.eR4t G `� _ www.newportbsachca.gov 1 (949) 644-320D
Application for Report of Residential Building Records
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# of Unlffi Address: I � City. Newport Beach State: DIP: r
Property Owner.70A v\ "" �, cJrz 1 Zip Code;.®
Owner Address: cl12i n A Y yy� an� I oty. �' %' i r./���-g-!'} j.�P/ �J�� g��+
state:. Zip Code: K. J®:sa-, Home Phone: e l l."[ 2LV `W (/'45
Owner's Authorized Agent: cr�, \ Work Phone: I qqzk 147
Agent Address: " 7 s•C, City:C'tn
state: F(TZip Code: . Agent Email Address:`
Email Report to:
For Inspection call (Name): Direct Phone: I
CONSENT TO INSPECT (FORM MU57 BE SIGNED & DATED BELOW)
rawthnrize lmpectrons.and.rrinspections'ofthe property fisted above. I understwrid-that.11` By.11dingerZoning.
vralstiofts arediscovered'I violations.
Owner/;4gent'ssignature•toauthonFze�usspe�ion:
Date..
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Owner/Agenes:sigmaturety decitee.inspectibn, C V Date,.
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Account # 01050504521040 .................Make checks payable to., CTTY OF NEWPORT.SE,4CH
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