HomeMy WebLinkAboutR2022-0073 - Permit Application=,_
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
PU' fl BUILDING N
10D Civic Center Drive � P.O. Box 176868 1 Newport Beach, GA92658-8915
RBR# www.newportbaachca.gov 1 (949) 644-32DO
Application for Report of Residential Building Records
: APPHE3 iora Fee:: - Notice:;
. (F5rAl14iesideritiab.Byi{dCngs)' Applicatfonswith.ihsuffeient•Fee•payinent:
Reinspection F.ee,$525:0q: orincvmplet'e wiMbej.;eturriedl
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PropertyOwner. " YVA+A * 1 Zip Code:. 1 !��
Owner Address: I a v 1 A V-0vonCity. 1 �I (� � �-emdr-'
State: CA Zip Code: Home Phone: 1 qqC( q' -L0 (u l-0
Owner's Authorized Agent: ' Work Phone: q�-t-1
Agent Address: I City: Ar �
State: Zip Code: q ZU Agent Email Address::
Ion fir" IN 0099M
IMM
Email Report ta:
For inspection call (Name); Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW]
raarthorze Inspections.and re iuspe�ion'saf.'the property listed above. I understan6-thatif SghdirigorZonfng.
vrotationsare.discovereda W.ilFbe:respnns hl'eto correctsald viblet{ons.
Owrrer/Agent:'signature•to.authoniie•fnspectfauv Date.,
OR
Owner/ -Agent" ssigraatureto decilne.inspectibn:
aWm�61u41on\Form.\Ran B]8 -a9
Date'.
Account # 01050504521040 .................Make checks payable to: aTY OF NEWPORT BEACH
Please type or print and complete
all lnfDrmatiDn
# of Units: I 11 I Address; ,
K 0 Y 0 Y\
Oty; Newport Beach State:
Zip:
PropertyOwner. " YVA+A * 1 Zip Code:. 1 !��
Owner Address: I a v 1 A V-0vonCity. 1 �I (� � �-emdr-'
State: CA Zip Code: Home Phone: 1 qqC( q' -L0 (u l-0
Owner's Authorized Agent: ' Work Phone: q�-t-1
Agent Address: I City: Ar �
State: Zip Code: q ZU Agent Email Address::
Ion fir" IN 0099M
IMM
Email Report ta:
For inspection call (Name); Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW]
raarthorze Inspections.and re iuspe�ion'saf.'the property listed above. I understan6-thatif SghdirigorZonfng.
vrotationsare.discovereda W.ilFbe:respnns hl'eto correctsald viblet{ons.
Owrrer/Agent:'signature•to.authoniie•fnspectfauv Date.,
OR
Owner/ -Agent" ssigraatureto decilne.inspectibn:
aWm�61u41on\Form.\Ran B]8 -a9
Date'.
Account # 01050504521040 .................Make checks payable to: aTY OF NEWPORT BEACH