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HomeMy WebLinkAboutR2020-0809 - Permit ApplicationGOMtytf`i City of Newport " %5ZCOMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION n t� 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8$tS m RSR# 1`104 ��O I www.newportbeachca.gov (949)644-3200 011 OF N&6 E'N`n Application for Report of Residential Building Records Application Fee::- $191.00; - Notice:; (For AII!Residentfid Buildings) - Applications; with ins uffcientfee payment Reinspection Fee: $12%00 or incomplete will. be: returned Please type or print and complete all information # of Units:FT Address: 1 I City: Newport Beach State: �Zip:� Owner Address: State: Zip Code: Neo 1-lAhk3411 Zip Code:. Home Phone: LV, U Owner's Authorized Agent:.IN WE, Work Phone: q N /i ?iu'j • 10 LP i Agent Address: 52© Y, City: "oA !0,pltya ��'�//�/��� 4;krlfG"0 State:, Zip Code: t Agent Email Address: MEW I LY I Rol FIRTIZIN71 MON ■fiT WOR �,l�.i�� 1C .. .-W�'�'...-�_, Ili G•�'�' ..� , Email Report to: For Inspection call (Name): Direct Phone: CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) Ia.uthor.'rze inspections.and.re- nspections afthe property listed above. I unde.rstand,that.if Building or Zoning. violationsare.discovered I wilfbe.responsibl`e.tocorrectsaid violations. Owner/Agenfssignature to authorize inspection: OR Owner/Agent's signature to decline. inspection: Account # 01050504-521040 .................Make checks Date:. CITY OF NEWPORT BEACH 6.114 ng_DwW.n\Farms\RBR S18 X8 7