HomeMy WebLinkAboutR2020-0855 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
t BUILDING DIVISION
V 10 z0 6 .j,ee1,7511,� 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RSR# t www.newportheachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
- Application Fee:: -$:, (q H Notice::
(For Ali.'Resfderitial.Buildi,ngs)' Applications; with. fnsufficfentfee.payipent
Refnspection Fee:$.129:U0: or incomplete willbe: returned
Please type or print and complete all information
# of Units: F, e Address: NO N iGi. city: Newport Beach State: EIZip: et L (q(P3
Property Owner. )nj Y nj-,, Trp Code..
Owner Address: ; Q 2- city
State: Zip Code: Home Phone:
Owner's Authorized Agent: ` Q S Work Phone: `I 14 (Pw t
AgentAddresss: I 1'lo Wv, , City: e .e0.L
State * I Zip Code:q'Ldo Agent Email Address:
Email Report to:
For inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
lauthnrize ir.spections.and.re=inspections ofthe property Ifsted above. I understaridahat.ff Building or Zoning.
violationsare.discovered:I wiff be:re'spn.nsible.to correctsa:fd violations.
Owner/Agentfssignature'to authorize ihspectfam, Date;..�L
Owner/AgenY'ssignature tD decline. inspection:
emmin`omisiun\Forms\aen s -ie -u
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Account # 01050504-521040 .................Make checks payable to: CITY Of NEWPORT BEACH