HomeMy WebLinkAboutR2021-0070 - Permit ApplicationPrint Form
City of New ort B h
C,, -WEU rjy.
COMMUNITY
EI.OY'Itt�i`I-
p eau
COMMUNITY DEVELOPMENT DEPARTMENT JAN 2 R ZOZI
n BUILDING DIVISION
�t
RBR# 2.®° U10100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915PIYY `1r:
www.newportbeachca.gov1(949)644.3200 w�
)lication for Re
ARRIlcation fee, - $194.00
(For AIIResidentiai Buildings)
Reinspection Fee $129.00
t of Residential Bu
Records
', yF Ot'rt
Notice:
Applications with insufficient fee payment
or Incomplete will be returned
Please type or Print and complete all information
t eI h�
# of Units: Address; q� � a� City: Newport Beach State: CA Zip: �{l(,d.5'
Property Owner. I tlar t'y n
f, '"^rUZip Code:
V7
Owner Address: 7D 6A R116~JA City: bn.{. C�
State: CA Zip Code: g39y-i
Home Phone:
Owner's Authorized Agent:I (ou�-I ��` work Phone:
Agent Address: /a ftnL+v 95YLG/"Q-' V1 City: D'G :J IVfJ
State: 75 • Zip Code: I "J Agent Email Address:9� %%�C
rJ ./ GYItiLV(
Escrow Company: O+ _. sLV J
P Escrow #; CE lTQ otoX4 -7 _ H -rte
Escrow Address: p`i(3z{ mGv't 5� ,S-iL I �Cj City: I , n.�..l�py-,• e J
State: �— Zip Code: Q� (�$ J�
I � Escrow Phone!
Email
a -
Email Report to:
For Inspection call (Name):
Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. l understand that if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Date:
Owner/Agent's signature to decline inspection:---e�/�'
_Date: 1 Zk Z/
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
OuiltllnA OlVisipO\forms\flOfl )3030