HomeMy WebLinkAboutR2022-0035 - Permit ApplicationPrint Form
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
%% BUILDING DIVISION
V1011--06 D 00 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: -$198.00 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
#of Units: ��I, Address `j SGr SUV°n0 City: Newport Beach'.. State. CA Zip:
PropertyOwner: %AVI� Ciarmbhk\ ! Zip Code:
Owner Address: L5 U�Y\ .... City:Wewpof k ,
State.CA _ Zip Code I U�JS% Home Phone: Q /f
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Owner's Authorized Agent Work Phone:
Agent Address. City:
State:I Zip Code: Agent Email Address:
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Escrow Company: �Vf,Cr�Ov�, L`-�C.roc,J- Escrow#: QGjtjla�"Uw
Escrow Address: Ira,00 �2Wivork Cent f lir._ 1 (j City: NeW�,or4 j3e-acin
State: Zi Code:
PC1a(pG%.... Escrow Phone: I qyci-(,q-I-3g39 _ -li
Email Reportto:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent's signature to decline inspection: - Date: )(jej Z.aZZ-
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