HomeMy WebLinkAboutR2022-0037 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
9?0 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RSR# 1� UU (( www.newporthsachra.gov 1 (949) 644-3200
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. (For.'AIIUiesideritial.Buiidf'ngs)' kpphcati'onswith.iissuffcient•fee•peymenC
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Please type or print and complete all Information
# of Units: 11
I Address: 1 C'V' City; Newport Beach State: CA Zip:
Property Owner. r ZpCode:.
Owner Address: TZ6 wvotcity ��/�/
State: C� Zip Code:. Home Phone: -4 "t �(J W 2, Q
Owner's Authorized Agent: Work Phone:
Agent Address: city:
State: Zip Code: Agent Email Address:
MOVED
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Email Report to:
For inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Pauth'artze inspectrons.andre-reispection'saf•'the property listed above. l understand•thatif B'u.fldingorZoning.
viblatwnsare.discovered:l v✓.ilibe:responsibl''e.to correctsaid vibiations.
Owner/Agents signatore•to•authorrtie rnspectinm:
Dotef
OR
Owner/Agent'ssigmature�to chiline.inspectibm: Date.: �2' _-Zel2'Z J
Account # 01050504-521040 .................Make checks payable to: CITY DP ❑IEwPUK r stacn
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