HomeMy WebLinkAboutR2022-0087 - Permit ApplicationvEcelvab aY
COMMUNITY
City of Newport Beach DEVEI.OPMENT
COMMUNITY DEVELOPMENT DEPARTMENT FEB 2 3 2022
BUILDING DIVISION
�n O� �O 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# 1� www.newportbeachca.gov 1 (949) 644-3200 CITYOF
Application for Report of Residential Building Re orC7_qRT BEI"°
Please type or print and complete all information
#ofUnits: I Address: 2 I ( .m City: Newport State: CA Zip:
PropertyOwner.,"T'-r /.� L� ..� -_ [ Zip Code �p� V
Owner Address: 2 2_6_.___...Q_ro i Ima.._r...1�—�-- City: _N .vh _._ _...
State: ICA Zip Code: ! „ C) Home Phone: I�
Owner's Authorized Agent: `1 Oh .... l✓ C./1 I Work Phone: N
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Agent Address: 2 _. _-l�iQ___ ___:. _.. I v V._� _...I
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State: r— Zip Code 2 u i Agent Email�Address: '^ I //',+
Email Report to: I V tAhnel
For Inspection call (Name): Direct Phone: f
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CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)