HomeMy WebLinkAboutR2020-0847 - Permit ApplicationPrint For City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT UC. 01 2020
BUILDING DIVISION
U� � 100 Civic Center Drive P.O. Box 1768 1 Newport Beach, CA92C5pMi5
RBR# `f www.newportbeachca.gov 1 (949) 644-3200
Application Tor tteport or tcesiaenalal tsuiiaing Itecoras
Application Fee: - $194.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type Or print and complete all information
# of Units: Address: 1 �Q'n C�Y1 City: Newport Beach State: CA Zip: q2—Co(o 1
PropertyOwner: 9\)Sc�mao �ewal )oymnuo— Zip Code: 2zio
Owner Address: -jy e(jyj V S I "\`w 1 City:
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State: A Zip Code: Phone:
Owner's Authorized Agent: r�T '� �� y(YyQ� Work Phone: N0,3sq,
Agent Address: ' W�Skclk `�'CiJ-Q� r^-+ City:
State: Y Zip Code: q -2W � Agent Email Address:
Escrow Company: t` (r v ) t-Aae ESCrC�) Escrow #:
Escrow Address: Q1 `eS S1v1mJ (C e� ivel ��/� City.
State: Zip Coder q �.J Escrow Phone: I qqq (p S1 - S i Zcl
Email Report to: .Its v he ftkh ee\Jl '(_VW , com
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For Inspection call (Name): ( `TQV��JI )y- /I Direct Phone: 6
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 responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
OR
Owner/Agent'ssignatureto decline inspection:
Date:
Date: I cl,2j'). 202—D
Account # UIU50504-521040 .................Make checks payable to: CITYOF NEWPORT BEACH
BAdf, DMA.\Form:\RBR 7-30-20