HomeMy WebLinkAboutR2022-0064 - Permit ApplicationY
Print Form City of Newport Beachl
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION �V
�ll A 7rj �C01n 100 Civic Center Drive f P.O. Box 1768 Newport Beach, CA92658-8915
RBRii li I/ ll' www.newportbeachca.gov 1 (949) 6443200
Application for Report of Residential Building Records
Application Fee: - $196.00
Notice:
(For All Residential Buildings)
Applications with insufficient fee payment
Reinspection Fee $131.00 or incomplete will be returned
Please type or print and complete all information
;f of Units;r Address: G S �` City: Newport Beach State: Zip: q j
PropertyOwnenl V q� j4�- ^�� Zip Code: q
Owner Address:/ ,/�j
.3. . C..rev G .5� city: . �,,,% .....
State: CA Zip Code: ii _ j'., /") Home Phone; �—
Owner's Authorized Agent: Me (•11 k�x lob
work Phone: F—
Agent Address: t -�/ 1. lii'i f �.C) Citv: 5.
state:) ��1� Zip Code: ./j'l/.,fY
Agent Email Address:
Escrow Company: r rcio Escrow
Escrow Address: k'p city:
State: Zip n)fEscw Phone: %?i t/role
Email Report to;
t�'/rrr>lr:.1"eroiLl.
For Inspection call (Name): Direct Phone: F
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
1 authorize inspections and re -Inspections of the property listed above. I understand that if Building or Zoning
violations are discovered Iwili be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
KO
Owner/Agent'ssignature to decline inspection:
Account 4 01050504-521040-- ............. Make
Buildir�0�W5kn�Femx�RBA 7.1-21
CA,
Date: I
Date: 02 1 09 / 2022
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Doc ID- 34d0791498bG9t7aa572adaO24o4O26357e5b8O3