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HomeMy WebLinkAboutR2022-0021 - Permit ApplicationM City of Newport Beach COMMUNITYUILDING DIVISION DEVELOPMENT DEPARTMENT 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92 RBR# !/ - www.newportbeachca.gov 1 (949) 644-3200 Application for Report of Residential Building Rec YtECkIV�4 Yy ©E� oP eroi- JAN 18 zoz2 58-8915 f- ryop rd oRT BEPr-O Apolicatloh Fee: *. $194.06 Notice:,- (For AIIRe'sidential Buildings) - AIppltcaLlons With Riiinspection;F.ee$ ]29:80 �:� or in, o'' lete.inril nsuffteientfee payment be returned Please type or print and complete all information 1 City: I wport Beach Staje: -__..... _---...._I : .... CA ;Zip:#of0nits�Address. Zip Code: Property Owner. 71- Owner Address: 53 CSL'SF'L�__. �6 _L4Ay ... ..... ... I City: L1gCk; _l- State: �-iJV - Zip Code g� r''� - Home Phone:[00 ............. .. L IM -7 Q(p ( Owner's Authorized Agent: (.0.0..,. _._.--:. Work Phone..: .:-_...--. Agent Address:City: Lou; _Ve o-,( Zip Code: F , / State: Agent Email Address: �n ............. - Escrow Company:._S"f.'ftCl LSCaaW .Escrow# OQ Escrow Address: State:- C (S30I_._.Y.°1(1AI�✓lAl�t°.3.QScty:-..S�nectv>..C�a-.. ._. ,. ,, Zip Code CI Escrow Phone: ... .(8.138 �,,,1;/��- ..... ...... Email Report to:10_eSL"�:UTAI._C°A.h�L.......... ................... ... ........ For Inspection call (Name): .�C C,e bS r, r� ' Direct Ph ,..........-.... -..-_._......-...i die ,l 3W _ O i l ispections and re -inspections of the property listed above. I understai Owner/Agent's signature-to�authorize Inspection: te. I; OR Owner/Agent's signature to decline inspection: E to; - Account # 01050504-521040 .................Make checks payable to: CITY OF NEWP RTBEACH Bulldln,Divlslon\Porms\0.BP )d0-20