HomeMy WebLinkAboutR2022-0033 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
V(� )1�/II/ /�o�/J 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
An, U J www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records
Application Fee: -$198.00Notice:
(For A1tResidential 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:Address: IO lff2s'C ` COUP 1 City: Newport Beach State: CA Zip: �a(0(O`%) ,
Pro pertyOwner: pp , Zi Code: `a&u 3 I
L, P
C41Uc-� Car�GQrSotl .......
Owner Address: 1 , City: N2W or,� j
State: CA Zip Code: V1a(P (0 Home Phone: ij
Owner's Authorized Agent:
Agent Address:
Work Phone:
I
City:
State: Zip Code: I Agent Email Address:
Escrow Company: n CrVnW_ Escrow tk:0551k(o--- �c W
Escrow Address: I'dU0 Ne Ur.�r Cer�T� r =1�0 City: NeW o,..} Fics,Jn
State: Zip Code: ga(a(D� Escrow Phone: ggq-.(00t4t-1 -
Email Report to: LZU�-_�Gek�'
For Inspection call (Name): / Direct Phone: hl
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: I0r 2.—