HomeMy WebLinkAboutR2021-0218 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
�Z �® 1 DO Civic Center Drive P.O. Box 1768 1 Newport Beach, CA926SM915
RBR# I L www.ne-wportheachca.gov (949) 644-3200
Application for Report of Residential Building Records
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Owner Address: U e i IC Oh^ 10 �' V\Ck
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State: F-07�-7 Zip code: . Agent Email Address:
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Email Report to:
For inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
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Account # OICSOSO4-SZ1040 ..... _.......... Make checks payable to., CnY OF NEWPORT.BEACH
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ProperryOwner.' (f5 ZipCDdec. (!(2
Owner Address: U e i IC Oh^ 10 �' V\Ck
Zip code. 7.• Home Phone: L[q 2,&0 1 U7v0
Owner's Authorized Agent: Work Phone:�LfCly� p �( `
Agent Address �o —gx"4 ooygv OLY U n , ' \ 'C) I`i
State: F-07�-7 Zip code: . Agent Email Address:
r
�.'�SAIMO'�I
_ , l 11
Email Report to:
For inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Fasrtics=' inspectiorss.andrL3l'aspechionsa£theprope.rLylistedabove. Ionderstand-thatif5cuWingwZoning.
vfolationsarediscovered.1Wi bd espcns11aletocorrectsaidvfalations.
Owner/'Agent`ssignaturetoauthamze�uisPediD.ne
Damsigriegypq
Owner/AgenVs;5igrratuce4a dedil:einsgechibe: � A'S r• i Date_ : � —
graFsrcagaacna
Account # OICSOSO4-SZ1040 ..... _.......... Make checks payable to., CnY OF NEWPORT.BEACH
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