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HomeMy WebLinkAboutR2022-0031 - Permit Applicationaye-skywis, awn, ;? ler ar,c City of Newport E ea' h COMMUNITY DEVELOPMENT DERkATMENT f V V V 1 BUiB0 Z • jd 140 Civic Center Drive I P.O. Boxox 1 176868 1 NNe RBR# www.newportbeachca.gov i(9 a 9) 01 Y' tPeach, CA 92658-8915 1 44-3200 Application for Report of Residential 441 Wing Records Application Fee: -$198.00 (For Ailitesidential Buildings) Reinspection Fee 5131.00 applications with insufflcientfee payment pdancomplete will be returned I' Please tvtse or print and complete li i ff matiop t4 of tissits: P�ddreaa: --- CIFf' 8eash' State;: rG Property Owners t // r� /' /.�.. ( Zip Code; �— Owner Address: E/ City: State: FCA lff �,r/y�C� Ho me`,IPhcn" Owner's Authorized Agent, •! r� f� ,p c/i �4 CiG �a�-iyr�� ork Fkione: r�Lf Agent Address: Ej G1IC �q`lt'�1���1!v^ s,r -•oma City: State: Zip Code: ,,�y� I`_J G(r,,%(G' Agent Email Address: Escrow Company: Escrow Address:Lto ) ..i �/'{�. rFIu Escrow #: Ut / ,I�(%��— //������iiii /a?{ - State! I ul Zip Coda: j2t,iJ/.+%(./ �`cc�" `��^' Escrow Phone:`� i Emall Report to: Cfr f� iCa �tfr't L" trrx .� GT 5&iewwr 1 C. K- r U For inspection call jName): CONSENT TO INSPECT IFORM MUST BE SI NE6 & DATED BELOW I IauthorizeInspections and re -inspections oftheproperty listed abov .Iunc�erstandthatifDulldingorZon)ng viotaiionsaredisroverediw)flberasponsibtetocoaeasaidviolaiton . Owner/Agent's signatureto authorize Inspection: Date: Owner/Agent's signature to decline Inspection- I" Date: (•• (2� i +Account#A1050504S2JA .................Mpkeche pa . o;±f17YOFAIIEWPORTiMCH emamr.P�+sanvm+rawaR)aa s is i aye-skywis, awn,