HomeMy WebLinkAboutR2021-0796 - Permit ApplicationP- 2U21-OT9,(v
City of Newport Beach Xv V!UN„Y
COMMUNrrY DEVELOPMENT DEPARTMENT `' r"r t"'
BUILDING DIVISION n1/
100 Civic Center Drive P.O. Box 1768 1 Newport Beach, CA926513- '� �OZi
RBR# GUUI (J l I W www.newportbaachca.gov 1 (949) 644-3200
C'I 'Y'*
Application for Report of Residential Building Records
,4noRcatibe Fee:::-$( �q a • Notice.;
. (•stir'AIIViesrderitiaLByildings)' ApRHcatibns+ with. rnsiuFfcient•fee'peyinent:
fteinspectionFee:$129:DDS: or•fircompletewillaie;tieivr'ried: ,
Please type or print and complete all information
# of Units: M Address:J5 Wq Sp City; Newport Beach State: E1Zip: 1 C 1
Property Owner: qYf YY\ Zip Code:. q z(xfi
Owner Address: city; -4—
State: Zip Code: �(Q Home Phone: I T-1 l Z &0 10 ZQ
Owner's Authorized Agent: I l� Work Phone:
Emall Report to:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
t'aulthcrize inspectron's.andre-iizspectionk-ofthe property listed above. I anderstand•thatrf B'u.ildg•o
inrZoning.
violationsare.discovered:I W.!ll;be:resp&nsihl'e.to correctsaid VoWtfons.
Owner/;Agent'ssignature•to•authoniieinspectaam:
Owner/Agent'ssignatureto decirae.inspectinc�:
aWlmnLob4len\Forms\P9�F]&)H
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
'7 (�'
.iNWIN
0KUM,
"�"
9181121"A WIMANO "M
Emall Report to:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
t'aulthcrize inspectron's.andre-iizspectionk-ofthe property listed above. I anderstand•thatrf B'u.ildg•o
inrZoning.
violationsare.discovered:I W.!ll;be:resp&nsihl'e.to correctsaid VoWtfons.
Owner/;Agent'ssignature•to•authoniieinspectaam:
Owner/Agent'ssignatureto decirae.inspectinc�:
aWlmnLob4len\Forms\P9�F]&)H
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH