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HomeMy WebLinkAboutR2021-0407 - Permit ApplicationDocuSgn Envelope ID. 60860309-FE3B-4098-A992-964C5E46D458 �OENED 9 , I PrilrtForm City of Newport Beach OOMMUNITY COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT BUILDING DIVISION JUN U 12021 o o 100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA92658-8915 RBR# Uy�V www.newportbeachca.gov 1 (949) 644-3200 CITY OF _a Appilcation Tor Keport OT KeSiclentia) Building Reuy"PT v,EP 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; 2223 OpctI f%evme _ - City: Newport Beach State: CA Zip: Gi�entp2, .._' t ... _ F F F Property Owner:l ?23 QIl'.�611. LAC 1 _ Zip Code: ; Owner Address: S3 tvr�pS led CtoUd ....wgrl _ City: Lbs VP > .S State: ICA _ Zip Code: %g135 Home Phone: (102)ya'4-©(PS2 Owner's Authorized Agent, I Cp�e -rvi?p Work Phone: D92 Agent Address: I 153bi Viey1+iAro BJvd 13'3J`J city:I eherman oG�--s State: F CA Zip Code: ;►{,Li(�3 Agent Email Address: G"p,ft�CO��IhVFS%I't'1ey�'}�}"(%UP. LgYI'1 Escrow Company: SAA11(0 CC,. C r w Escrow #: Escrow Address:: �� fiO� V2vrVura _ g*Vrh Pa31)5 city: Sh-eYmah onV s State: F Zip Code: FYI t 0 Escrow Phone: ($1 2s) 3g2 (i) `1'O Email Report to:-�YancMee sivCh'O f &rf-ow. cc)YYI For Inspection call (Name):I,i�anG(ne WY`OWV) Direct Phone: FQ)�)3�2"t-it2�('j- CONSENT TO INSPECT !FORM MUST BE SIGNED $e 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: Date: OR OocuSigned by: Owner/Agent's signature to decline inspection: int-fi l�i,gM,uAL{^ _Date: 5/17/2021 ~� aengooaessiaic... Account It 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH Building Division\Forms\RBR 7-30-20