HomeMy WebLinkAboutR2021-0610 - Permit Application, fit=.CEivEp 6I.,
City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION 1MG 2 O 2021
WOO OO Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
l www.newporthaachca.gov 1 (949) 644-3200 � .v OF
Application for Report of Residential Building Record "S 1VL -r
= Avolimtibri F'ee::-$I (q "I • Notice:: .:
Foc'All�esideritia4.Buildings)' kpplicatians:withihsnf..ficient•1=ge•payment •
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# of Units:1 Address: (` City: Newport Beach State: ElZip:
Property Owner�� �I y �S (iiKX't;Y �PCode:. Z�✓
Owner Address: City:
State: CA Zip Code: Home Phone: C(�
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: Zip Code:' / I Agent Email Address:
Escrow Company: Escrow #: r
Escrow Address: jC�� City:
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State: Zip Code: '--i.4c+.�-�r Escrow Phone: '1
Email Report to:
For inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MIDST BE SIGNED & DATED BELOW)
Pautharfze inspectroris.andre-inspection's of -the property fisted above. I anderst-crid•that.if B'ga'IdingorZoning
vidlationsare.discovered'I will:be:respnnsibl'e.to correctsaid viblations.
OwnerI-Agent:'ssignstare•to•authaFfte-I nspectiam:
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Owner/AgenY'sMgmaturetadeciine.inspectrom: Date::
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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