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HomeMy WebLinkAboutR2021-0843 - Permit ApplicationCity of Newport Beach COMMUNITYDEVEtOPMENTDEPARTMENT' BUIt.DING DIVISION 100 Civi , c Center Drive (P.O.Box 17£8 [ NewportSeachjCA 92658-8915 UU�\ RBR# + wwW-newoortbeachca.env ( (949) 644-3200 "�,J Piease twee or print and; comDieie a!1 information #of Units. M Address ; eavBrzt{3 City �,_,r � :: rftsath.... Sate Property Owner ZipUode fsAOsTS=:tom:.._ .j... r„ .....___ ..__r Owner Address ha O ,t lrlar..,: m t 'eAveatxe , .r _ _.._... ...._„ . _......r City a.. State Zip Code Nome Phone;m_.._.ga='v..... Owner's, Authorized Agent P Ito_. t Bfi .a _._a "E ar.e °� ..._.. _ vm Work Phone:: CONSENTTOINSPECT(FORMMUST9ESIGNEDANDDATED` ttOW'; Account # 01050504-521040. ..... Make.chechs payable to CITY OFNEWPORT BEACH' m ea• ° eab `m- •ea - m ♦m- ai{ ♦ ♦ Q { Q -e♦ ♦ ♦.. - e m m m m• ♦ ! • - CONSENTTOINSPECT(FORMMUST9ESIGNEDANDDATED` ttOW'; Account # 01050504-521040. ..... Make.chechs payable to CITY OFNEWPORT BEACH'