HomeMy WebLinkAboutR2020-0932 - Permit ApplicationPrint Form
RBR#'92-DY.O• 0932
City of Newport Beach ��GEIVED a�•
COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-BOT53 0 2020
www.newportbeachca.gov 1 (949) 644-3200
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Application Fee: - $194.00
(For All Residential Buildings)
Reinspection Fee $129.00
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Notice.•
Applications with insufficient fee payment
or incomplete will be returned
Please type or print and complete all information
#ofUnits: FAddress: 213(8 V)gTAr Ll4✓LsDo City: NewportBeach State: CA Zip:92 60
Property Owner:&Y10VNn:5V\JFLL. IN�/F_-STVvIt`ViS L—IC- - Zip Code: F—
Owner Address: 3a 01�(rfa ( ,�. city: C•b_..M
State: CA Zip Code: Home Phone: 191-f� 'Z -I (7 _ bSz
Owner's Authorized Agent: I�(�-TI{-�/ l`-ALL0rJ Work Phone: q Wi( S2,9'� -67 -7 Z,
Agent Address: NrtAA[/LT CT,,L D2 +� f6bCity: N .
State: c— A- Zip Code: 0' 2 &6 o Agent Email Address:
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Escrow Company: 1 t; NTrG- (jUll_ F V Escrow #: 13 34 —QZa' < G -r
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Escrow Address: 90'O M \L.(-1 KC -&J P— City: t2.Ay>`ck) euC,4muJ(rA
State: F Zip Code: q n sO Escrow Phone: 76�G/Cl/ _ 6 If q.7.
Email Report to: a(\(\) -Ur(.- 0AC4MgtJE Fij C-om
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. I understand that if Building or Zoning
violations are discovered I will be responsibleto correct said violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature to decline inspection:
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Date:
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Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH