HomeMy WebLinkAboutR2022-0069 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
t 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 insufficientfee payment
Reinspection Fee $131.00 - or incomplete will be returned
Please type or print and complete all information
# of Units. � Address: 175.9 PaT ��/(% ^ n City: Newport Beach State: CA Zip: C%L-- 69 U
.. tU/�. Ck. e
Property Owner. 3W//l __(✓W.Lt�./'F ,J.1---.,,.j/i--_-tINi,GJ-__�ul,v Zip Code: F9
Owner Address: WIT ota&ity: (rr AN
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State: CA __., _ Zip Code: Home Phone:
Owner's Authorized Agent Work Phone:
�10 Agent Address: _. City:
State: 177 Zip Code F Agent Email Address:
Escrow Company: �<�Gf /' riZ%�} Escrow N:
Escrow Address:..ri� �r-r //d ed //o City:
State: Zi Code Escrow Phone:
Email Report to: `/ 11 /UL'. tLt{��1.�/�i�Jf �j�1��it/✓'. i� UY7 t. _.
For Inspection call (N me): a Direct Phone: _.
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOWi
I authorize inspections and re -inspections of the property listed above. I understand that if Building orZoning
violations are discovered I will be responsibleto correctsaid violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature to decline inspection:
Arrnunt H 01 nsw;04-S21n4n _............. ..Make
Building Oiuision\Forms\BBB ]-171
Date:
Dater
to: CITY OF NEWPORT BEACH